UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


SCHOOL  OF  LAW 
LIBRARY 


A    MANUAL 


OF 


MEDICAL  JURISPRUDENCE 


FOR    THE    USE    OF 


STUDENTS  AT  LAW  AND  OF  MEDICINE. 


BY 


MARSHALL  D.  EWELL,  M.D.,  LL.D. 
>// 

PROFESSOR    OF    COMMON    LAW    IN    UNION    COLLEGE    OF    LAW,    CHICAGO 
(LAW  DEPARTMENT   OF  THE   NORTH-WESTERN   UNIVERSITY). 


BOSTON: 
LITTLE,   BROWN,   AND   COMPANY. 

1887, 


r 


Copyright,  1887, 
BY  MARSHALL  D.  EWELL. 


PRESS  : 

X  \VlLSOX  AlfD  SOX,  CAMBRIDGE. 


PKEFACE. 


THE  subject  of  Medical  Jurisprudence  is  one  which 
does  not  receive  from  schools  either  of  law  or  of  medi- 
cine anything  like  the  attention  which  its  importance 
deserves.  The  author,  when  a  student  of  the  law  some 
twenty  years  since,  and  more  recently  when  a  student 
of  medicine,  did  not  have  the  benefit  of  a  single  lec- 
ture upon  this  subject ;  and  it  is  believed  that  many,  if 
not  a  majority,  of  the  law  and  medical  colleges  of  the 
present  day  dismiss  the  subject  either  with  no  attention 
whatever  or  with  so  little  attention  that  students  de- 
rive no  practical  benefit  from  the  instruction  given. 
For  a  medical  man  to  study  the  subject  (as  is  usually 
the  case  if  he  studies  it  at  all)  clinically,  so  to  speak, 
as  the  defendant  in  an  action  for  malpractice  or  as  a 
so-called  expert  witness,  while  certainly  calculated  to 
make  an  impression  upon  his  memory,  cannot  be  said  to 
be  wholly  agreeable  and  profitable.  On  the  other  hand 
it  is  not  uncommon  to  see  attorneys  engaged  in  the 
trial  of  cases  involving  important  interests,  betray  cul- 
pable ignorance  of  this  subject.  The  attorney,  to  whom 


iv  PREFACE. 

is  intrusted  the  trial  of  a  case  involving  an  important 
question  of  Medical  Jurisprudence,  who  has  a  good 
knowledge  of  the  leading  facts  and  principles  of  medi- 
cine and  of  their  application  to  Medical  Jurisprudence, 
possesses  an  immense  advantage  over  his  adversary  who 
is  not  possessed  of  such  knowledge ;  and  no  amount  of 
preliminary  "  cramming  "  will  supply  the  place  of  pre- 
vious general  knowledge  of  the  whole  subject.  It  is 
the  deliberate  judgment  of  the  author  that  no  man  can 
be  said  to  be  prepared  for  every  emergency  which  may 
arise  in  the  practice  of  either  law  or  medicine  without 
a  very  considerable  acquaintance  with  the  science  of 
Msdical  Jurisprudence. 

There  are  so  many  uniformly  excellent  treatises  on 
this  subject  that  there  seems  to  be  no  need  for  another ; 
but  these  works  are,  as  a  rule,  so  large  as  to  take  more 
time  for  their  perusal  than  the  student  at  law  or  of 
medicine  has  to  bestow  upon  them;  moreover,  most 
of  them  are  quite  expensive.  The  experience  of  the 
writer,  both  as  a  student  and  teacher,  has  led  him 
to  believe  that  a  work  which  within  a  moderate  com- 
pass states  all  the  leading  facts  and  principles  of  the 
science,  concisely  and  yet  clearly,  will  prove  useful  to 
students  of  both  professions ;  this  work  was  accordingly 
undertaken.  It  does  not  claim  to  be  more  than  a  care- 
ful compilation  from  what  seemed  to  be  the  best  au- 
thorities of  the  leading  principles  of  the  science.  It 


PREFACE.  v 

is  believed,  however,  that  within  the  moderate  compass 
of  this  volume  will  be  found  the  substance  of  all  the 
principles  stated  in  the  more  voluminous  works.  Two 
exceptions  should  be  made  to  this  statement  as  respects 
the  subjects  of  Insanity  and  Toxicology.  To  treat 
either  of  these  subjects  with  anything  like  complete- 
ness would  require  more  space  than  is  occupied  by  the 
whole  volume ;  it  was  therefore  thought  better  by  the 
author  to  treat  with  a  reasonable  degree  of  complete- 
ness the  other  subjects  usually  discussed  in  works  upon 
Medical  Jurisprudence,  giving  an  outline  only  of  these 
two,  than  by  attempting  to  cover  the  whole  ground,  in- 
cluding Toxicology  and  Insanity,  to  make  the  whole 
meagre  and  unsatisfactory.  Accordingly,  upon  the  sub- 
ject of  Insanity  a  brief  outline  only  has  been  given, 
which,  however,  it  is  hoped,  will  be  found  to  accord 
with  the  best  authorities  of  the  day.  As  respects  Toxi- 
cology, nothing  more  has  been  attempted  than  a  con- 
sideration of  some  general  principles  leading  up  to  the 
more  particular  study  of  the  subject.  The  reasons  for 
this  will  be  found  more  fully  stated  at  the  beginning 
of  the  chapter  upon  that  subject. 

In  order  to  save  space  it  has  been  thought  expedient 
to  omit  the  citation  of  authorities  for  the  different 
statements  of  the  text,  and,  as  a  rule,  they  have  there- 
fore been  omitted.  It  is  proper,  however,  in  this  place 
to  say  that  free  use  has  been  made  of  the  standard 


vi  PREFACE. 

European  works  upon  this  subject,  and  that  the  author 
is  especially  indebted  to  the  valuable  works  of  Ogston, 
Tidy,  Taylor,  and  Woodman  &  Tidy ;  special  acknowl- 
edgments are  also  due  to  Dr.  Spitzka,  of  New  York, 
of  whose  manual  upon  Insanity  free  use  has,  with  the 
author's  consent,  been  made. 


MARSHALL  D.  EWELL. 


UNION  COLLEGE  OF  LAW,  CHICAGO, 
Aug.  2,  1887. 


CONTENTS. 


CHAPTER  PAGE 
I.    INTRODUCTORY;    EVIDENCE;   EXPERTS;    COM- 
PENSATION;   RELATION    OF    PHYSICIAN    TO 

PATIENTS,  ETC 1 

II.    MEDICO-LEGAL  INSPECTIONS 17 

III.  WOUNDS,  BURNS,  AND  SCALDS 26 

IV.  THE  SIGNS,  MODES,  CAUSES,  ETC.,  OF  DEATH  49 

V.    DEATH  BY  ASPHYXIA;  DROWNING;  HANGING; 

STRANGULATION;  AND  SUFFOCATION  ...  72 

VI.    DEATH  FROM  HEAT;  COLD;  LIGHTNING;  AND 

STARVATION 89 

VII.     PREGNANCY 90 

VIII.     DELIVERY        105 

IX.     BIRTH Ill 

X.     ABORTION 115 

XI.    INFANTICIDE 120 

XII.     DEFLORATION  AND  RAPE;  SODOMY    ....  142 

XIII.  IMPOTENCE  AND  STERILITY 162 

XIV.  SEX,  HERMAPHRODISM,  AND  MONSTROSITIES  167 
XV.     LEGITIMACY  AND  PATERNITY 181 

XVI.     PERSONAL  IDENTITY ...  204 


viii  CONTENTS. 

CHAPTER  PAGE 

XVII.    LIFE  INSURANCE 261 

XVIII.    FEIGNED,  FACTITIOUS,  AND  LATENT  DISEASES  273 

XIX.    MALPRACTICE 282 

XX.    GENERAL  TOXICOLOGY 301 

XXI.    INSANITY 328 

XXII.    SOME  RULES  OF  THE  COMMON  LAW  RESPECTING 
THE  DISPOSITION  OF  HUMAN  DEAD  BODIES; 

LEGISLATION  UPON  ANATOMY,  ETC.    .     .     .  378 


INDEX 397 


MEDICAL    JUEISPEUDENCE. 


CHAPTER  I. 

INTRODUCTORY;  EVIDENCE;  EXPERTS;  COMPENSATION; 
RELATION  OF  PHYSICIAN  TO  PATIENTS,  ETC. 

WHILE  the  terra  "  medical  jurisprudence "  is  a  mis- 
nomer, —  the  collection  of  facts  and  conclusions  usually 
passing  by  that  name  being  principally  only  matters 
of  evidence,  and  rarely  rules  of  law,  —  still,  the  term  is 
so  generally  employed  that  it  would  be  idle  to  attempt 
to  bring  into  use  a  new  term,  and  we  shall  accordingly 
continue  the  employment  of  that  which  has  only  the 
sanction  of  usage  to  recommend  it. 

There  are,  however,  some  rules  of  law  pertaining  to 
medical  witnesses,  and  to  a  few  other  topics,  which 
may  properly  be  treated  in  a  work  like  the  present. 
No  space,  however,  will  be  occupied  in  discussions, 
often  to  be  found  in  works  upon  medical  jurisprudence, 
of  rules  of  law  which  have  no  especial  reference  to 
medical  practitioners  more  than  to  other  citizens. 

The  jurisdiction  and  practice  of  the  various  courts, 
and  the  rights  and  duties  of  witnesses  vary  to  some 
extent  in  the  different  States,  and  will  be  found  denned 
in  local  works  of  practice  and  the  statutes  of  the  differ- 

1 


2  MEDICAL  JURISPRUDENCE. 

ent  States,  as  well  as  to  some  extent  in  general  treatises 
upon  the  common  law,  and  it  is  beyond  the  scope  of 
this  work  to  consider  them. 

It  may  not  be  amiss,  however,  to  state  that  the 
subpoena  of  a  court  of  justice  cannot  be  disregarded 
with  impunity,  but  should  be  obeyed  promptly.  A 
failure  to  obey  may  subject  the  witness  to  attachment 
for  contempt. 

The  medical  witness  should  remember,  also,  that  by 
the  common  law  a  medical  man  has  no  privilege  to 
avoid  giving  in  evidence l  any  statement  made  to  him 
by  a  patient ;  but  when  called  upon  to  do  so  in  a  court 
of  justice  he  is  bound  to  disclose  every  communication, 
however  private  and  confidential,  which  has  been  made 
to  him  by  a  patient  while  attending  him  in  a  profes- 
sional capacity.  By  statute,  however,  in  some  of  the 
United  States,  communications  made  by  a  patient  to 
a  physician,  when  necessary  to  the  treatment  of  a  case, 
are  privileged,  and  the  physician  is  either  expressly 
forbidden,  or  not  obliged  to  reveal  them.  Such  statutes 
exist  in  Arkansas,  California,  Indiana,  Iowa,  Michigan, 
Minnesota,  Missouri,  Montana,  New  York,  Ohio,  and 
Wisconsin.  The  seal  upon  the  physician's  lips  is  not 
taken  away  by  the  patient's  death.  Such  communica- 
tions, however,  must  be  of  a  lawful  character  and  not 
against  morality  or  public  policy ;  hence,  a  consultation 
as  to  the  means  of  procuring  an  abortion  on  another  is 
not  privileged,  nor  would  be  any  similar  conference 
held  for  the  purpose  of  devising  a  crime  or  evading  its 
consequences. 

1  See  Jones  vs.  King,  cited  post,  in  this  chapter. 


COMPENSATION.  3 

A  report  of  a  medical  official  of  an  insurance  com- 
pany, on  the  health  of  a  party  proposing  to  insure  his 
life,  is  not  privileged  from  production ;  nor  is  the  report 
of  the  surgeon  of  a  railroad  company  as  to  the  injuries 
sustained  by  a  passenger  in  an  accident,  unless  such 
report  has  been  obtained  with  a  view  to  impending 
litigation. 

Compensation.  —  By  the  Eoman  law  the  services  of 
both  an  advocate  and  of  a  physician  were  strictly  hon- 
orary; by  the  common  law  of  England,  surgeons  and 
apothecaries  could  recover  by  law  remuneration  for 
their  services,  but  a  physician  was  presumed  to  attend 
his  patient  for  an  honorarium,  and  could  not  sue  there- 
for until  the  passing  of  the  medical  act  in  1858. 

By  the  law  in  this  country  all  branches  of  the  pro- 
fession may  recover  at  law  a  reasonable  compensation 
for  their  services,  the  amount  of  which,  unless  settled 
by  law,  is  a  question  for  the  jury ;  in  settling  which, 
the  eminence  of  the  practitioner,  the  delicacy  and  diffi- 
culty of  the  operation  or  of  the  case,  as  well  as  the 
time  and  care  expended,  are  to  be  considered.  There 
is  no  limitation  by  the  common  law  as  to  the  amount 
of  such  fees  provided  the  charges  are  reasonable.  The 
existence  of  an  epidemic  does  not,  however,  authorize 
the  charge  of  an  exorbitant  fee. 

A  medical  man  can  also  recover  for  the  services 
rendered  by  his  assistants  or  students,  even  though 
the  assistant  is  unregistered ;  it  is  not  necessary  that 
there  should  be  any  agreed  specified  price,  but  he  will 
be  allowed  what  is  usual  and  reasonable. 

It  is  not  the  part  of  a  physician's  business,  ordinarily, 
to  supply  the  patient  with  drugs ;  if  he  does  so  he  has 


4  MEDICAL  JURISPRUDENCE. 

a  right  to  compensation  therefor.  If  the  agreement  is, 
"  no  cure,  no  pay,"  he  cannot,  however,  even  recover  for 
medicines  supplied,  if  the  cure  is  not  effected.1  His 
right  to  recover  for  professional  services  does  not  de- 
pend upon  his  effecting  a  cure,  or  upon  his  services  being 
successful,  unless  there  is  a  special  agreement  to  that 
effect ;  but  it  does  depend  on  the  skill,  diligence,  and 
attention  bestowed.  The  practitioner  must  be  prepared 
to  show  that  his  work  was  properly  done,  if  that  be 
disputed,  in  order  to  prove  that  he  is  entitled  to  his 
compensation.  See  post,  MALPRACTICE.  Where  the  surgi- 
cal instruments  employed  in  amputating  an  arm  were  a 
large  butcher-knife,  and  a  carpenter's  sash-saw,  a  charge 
to  the  jury  that  if  the  operation  was  of  service  and  the 
patient  did  well  and  recovered,  the  surgeon  was  entitled 
to  compensation,  —  although  it  was  not  performed  with 
the  highest  degree  of  skill,  or  might  have  been  performed 
more  skilfully  by  others,  —  was  held  proper. 

If  a  surgeon  has  performed  an  operation  which  might 
have  been  useful,  but  has  merely  failed  in  the  event,  he 
is  nevertheless  entitled  to  compensation ;  but  if  it  could 
not  have  been  useful  in  any  event,  he  has  no  claim 
upon  his  patient.  A  medical  man  who  has  made  his 
patient  undergo  a  course  of  treatment  which  plainly 
could  be  of  no  service  cannot  make  it  a  subject  of 
charge ;  but  an  apothecary  who  has  simply  administered 
medicines  under  the  direction  of  a  physician  may  re- 

1  See  the  late  case  of  Jones  vs.  King,  S.  Ct.  Ala.,  1  South.  Rep. 
591  ;  24  Cent.  L.  J.  434.  In  this  case  it  was  held  competent  to  prove 
that  the  plaintiff's  medicines  were  worthless,  and,  moreover,  that  not 
being  patented  he  had  no  property  in  the  secret  of  his  remedy  such  as 
the  law  would  privilege  him  from  disclosing. 


COMPENSATION.  5 

cover  for  the  same,  however  improper  they  may  have 
been. 

The  number  of  visits  required  must  depend  upon  the 
circumstances  in  each  particular  case,  and  the  physician 
is  regarded  by  the  law  as  the  best  and  proper  judge  of 
the  necessity  of  frequent  visits ;  and  in  the  absence  of 
proof  to  the  contrary  it  will  be  presumed  that  all  pro- 
fessional visits  made  were  deemed  necessary  and  were 
properly  made. 

There  must  not  be  too  many  consultations.  The 
physician  called  in  for  consultation  or  to  perform  an 
operation  may  recover  his  fees  from  the  patient,  not- 
withstanding that  the  attending  practitioner  summoned 
him  for  his  own  benefit,  and  had  arranged  with  the 
patient  that  he  himself  would  pay. 

Where  a  medical  man  has  attended  as  a  friend  he 
cannot  charge  for  his  visits. 

Where  a  tariff  of  fees  has  been  prepared  and  agreed 
to  by  the  physicians  of  any  locality,  they  are  bound  by 
it  legally  as  far  as  the  public  are  concerned  (that  is  to 
say,  they  cannot  charge  more  than  the  tariff  rates),  and 
morally  as  far  as  they  themselves  are  concerned. 

A  physician  is  always  allowed  discretionary  powers 
over  his  patients  as  to  his  mode  of  treatment,  so  as  to 
be  able  to  alter  the  same  according  to  the  varying 
necessities  of  the  case.  Unless  such  change  of  treat- 
ment involves  a  risk  of  life,  or  consequences  of  which 
he  is  unwilling  to  assume  the  responsibility,  he  is  not 
under  obligations  to  give  notice  or  obtain  permission 
before  making  it. 

It  is  the  duty  of  a  physician  who  is  attending  a 
patient  having  a  contagious  disease,  when  called  upon 


6  MEDICAL  JURISPRUDENCE. 

to  attend  others,  to  take  all  such  precautionary  means 
as  experience  has  proved  to  be  necessary  to  prevent  its 
communication  to  them.  Where  a  physician  who  was 
told  by  a  patient  not  to  attend  any  person  infected 
with  small-pox,  or  his  services  would  be  dispensed 
with,  failed  to  say  that  he  was  attending  such  a  patient 
and  promised  not  to  do  so,  but  continued  so  to  attend, 
and  by  want  of  proper  care  communicated  small-pox  to 
plaintiff  and  his  family,  —  these  facts  were  held  proper 
evidence  to  go  to  the  jury  in  reduction  of  damages  in 
an  action  for  his  account,  and  the  physician  was  held 
responsible  for  the  suffering,  loss  of  time,  and  damages 
to  which  the  patient  was  subjected.  If  a  physician  by 
communicating  an  infectious  disease  has  rendered  a  pro- 
longed attendance  necessary,  thereby  increasing  his  bill, 
he  cannot  recover  for  such  additional  services  necessi- 
tated by  his  own  want  of  care. 

As  to  who  should  pay  the  physician,  but  little  can  be 
stated  in  this  connection ;  a  few  rules  and  principles 
however,  are  the  following :  If  A  says  to  B,  a  medical 
man,  "  Attend  upon  C,  and  if  he  does  not  pay  you,  I 
will,"  this  being  a  promise  to  answer  for  the  debt  of  C, 
for  which  he  is  also  liable,  the  promisor  cannot  accord- 
ing to  some  authorities  be  held  unless  the  promise  is  in 
writing,  signed  by  A  or  by  some  one  thereunto  by  him 
lawfully  authorized.  But  if  he  says  to  B,  "  Attend  C, 
and  charge  your  bill  to  me ; "  or,  "  I  will  pay  you  for 
your  attendance  upon  C,"  —  no  written  agreement  is 
necessary. 

A  person  who  calls  upon  a  physician  and  directs  him 
to  attend  upon  a  patient  may  render  himself  liable  for 
the  fees  of  the  physician ;  the  question  in  such  a  case 


COMPENSATION.  7 

is  whether  the  party  so  calling  the  physician  is  or  is 
not  a  mere  agent ;  if  he  is  a  mere  agent,  he  is  not  liable, 
but  otherwise  he  is  ordinarily  liable. 

A  wife  has  implied  authority  to  bind  her  husband 
for  reasonable  expenses  incurred  in  obtaining  medicines 
and  medical  attendance ;  but  this  implied  authority  is 
terminated  if  she  leaves  home  of  her  own  accord  with- 
out sufficient  reason,  and  the  fact  has  become  notorious, 
or  the  husband  has  given  sufficient  notice  that  he  will 
no  longer  be  responsible  for  debts  of  her  contracting. 
If,  however,  a  husband  turns  an  innocent  wife  out  of 
doors  without  the  means  to  obtain  necessaries,  he  sends 
his  credit  with  her,  and  in  such  case  medical  attendance 
is  undoubtedly  a  necessary.  If  a  physician  attends  a 
wife  whom  he  knows  to  be  living  separate  and  apart 
from  her  husband,  it  is  his  duty  to  inquire  whether  she 
has  good  cause  for  so  doing ;  if  she  has  not,  he  cannot 
collect  his  bill  from  the  husband. 

Although  the  law  favors  no  particular  school  of  med- 
icine, it  does  not  encourage  mere  quackery.  Where, 
therefore,  a  so-called  doctor  was  in  the  habit  of  putting 
a  woman  into  a  mesmeric  sleep,  who  thereupon  became 
clairvoyant  and  prescribed  medicines,  which  the  doctor 
furnished  and  for  which  he  sued,  the  judge,  in  deciding 
the  case  said  :  — 

"  The  law  does  not  recognize  the  dreams,  visions,  or  reve- 
lations of  a  woman  in  mesmeric  sleep  as  necessaries  for  a 
•wife,  for  which  the  husband  without  his  consent  can  be 
made  to  pay." 

By  the  common  law  the  duty  of  a  father  to  furnish 
necessaries,  including  medical  attendance,  for  his  minor 


8  MEDICAL  JURISPRUDENCE. 

child,  is  a  moral  obligation  and  not  a  legal  one.  The 
father's  liability,  if  it  exists,  is  put  on  the  ground  of 
agency,  and  the  authority  of  an  infant  to  bind  the  father 
by  contracts  for  necessaries,  including  medical  aid,  will 
be  inferred  from  very  slight  evidence.  Medicines  and 
medical  aid  are  necessaries,  for  which  an  infant  may, 
when  not  otherwise  supplied,  legally  contract,  and  for 
which  he  may  render  himself  liable. 

A  master  is  not  bound  to  provide  medical  assistance 
for  his  servant ;  the  obligation,  if  it  exists  at  all,  must 
arise  from  contract,  and  such  contract  will  not  be  im- 
plied from  the  fact  that  the  servant  lives  under  the 
master's  roof,  nor  because  the  illness  of  the  servant 
has  arisen  from  an  accident  met  with  in  the  master's 
service. 

A  master  is  bound  to  provide  an  apprentice  with 
proper  medicines  and  medical  attendance. 

Where  a  physician  or  surgeon  has  been  called  in  to 
attend  a  passenger  or  employee  injured  by  a  collision  or 
other  railway  accident,  the  company  cannot  be  held  re- 
sponsible unless  it  can  be  shown  that  the  agent  or  ser- 
vant who  summoned  the  medical  man  had  authority  so 
to  do.  It  has  been  held  that  neither  a  guard  nor  the 
superintendent  of  a  station  nor  the  engineer  of  the 
train  in  which  the  accident  happened  has  any  implied 
authority  to  bind  the  company  for  such  medical  ser- 
vices. In  England  it  has  been  held  that  the  general 
manager  of  the  railway  company  has,  as  incidental  to 
his  employment,  authority  to  bind  his  company  for 
medical  services  bestowed  upon  one  injured  on  his  rail- 
way. In  Illinois  a  similar  decision  has  been  rendered 
as  to  a  general  superintendent,  but  a  contrary  decision 


COMPENSATION.  9 

has  been  rendered  by  the  Superior  Court  of  the  city  of 
New  York. 

The  Compensation  of  Medical  and  other  Experts  is  a 
subject  which  has  been  somewhat  discussed  by  the 
courts,  and  upon  which  the  law  is  not  entirely  settled. 

Statutory  provisions  will  be  found  in  some  of  the 
States  regulating  this  question.  Thus  in  Iowa  it  is 
enacted  that  — 

"  Witnesses  called  to  testify  only  to  an  opinion  founded 
on  special  study  or  experience  in  any  branch  of  science,  or 
to  make  scientific  or  professional  examinations,  and  state  the 
results  thereof,  shall  receive  additional  compensation,  to  be 
fixed  by  the  court,  with  reference  to  the  value  of  the  time 
employed  and  the  degree  of  learning  or  skill  required." 

Similar  provisions,  more  or  less  extensive,  are  to  be 
found  upon  the  statute-books  of  North  Carolina,  Rhode 
Island,  and  Minnesota. 

In  Indiana,  by  statute,  experts  are  compellable  to 
testify  to  an  opinion  without  extra  compensation. 

While  it  is  the  general  practice  of  parties  employing 
experts  to  give  them  extra  compensation,  it  is  regarded 
as  having  been  paid  for  the  party's  own  benefit,  and 
hence  can  not,  in  the  absence  of  statute,  be  regarded  as 
a  necessary  disbursement,  and  hence  taxed  as  costs. 
In  every  State  there  can,  we  think,  be  no  doubt  that  an 
expert  cannot  be  compelled  to  make  a  preliminary 
examination,  such  as  the  analysis  of  a  stomach  or  the 
examination  of  an  alleged  lunatic,  so  as  to  enable  the 
expert  to  testify  in  court  as  to  his  professional  opinion, 
without  special  compensation.  It  would  seem  also  that 
an  expert  cannot  be  required  to  attend  during  an  entire 


10  MEDICAL  JURISPRUDENCE. 

trial,  for  the  purpose  of  listening  to  the  testimony,  with 
the  view  of  enabling  him  to  express  an  opinion  there- 
upon, without  special  compensation. 

In  the  absence  of  statute  and  of  such  preliminary 
labor,  can  an  ordinary  expert  witness  legally  require  the 
payment  of  special  compensation  as  a  condition  prece- 
dent to  his  testifying  ?  When  testifying  as  ordinaiy 
witnesses  to  facts  which  have  fallen  under  their  notice, 
they  stand  upon  the  same  basis  as  ordinary  witnesses. 
When  testifying  as  to  matters  requiring  professional 
skill,  the  question  is  not  so  clear.  In  England,  at  least 
in  civil  cases,  additional  compensation  seems  to  be  ne- 
cessary. But  in  England,  a  professional  man,  even  when 
called  as  to  facts  and  not  opinions,  is  entitled  to  extra 
compensation  on  the  higher  scale  allowed  under  the 
statute  of  Elizabeth  (5  Eliz.  c.  9),  which  provides  that 
the  witness  must  "  have  tendered  to  him,  according  to 
his  countenance  or  calling,  his  reasonable  charges." 

Writers  upon  medical  jurisprudence  have  generally 
been  of  the  opinion  that  witnesses  are  entitled  to  extra 
compensation  as  a  matter  of  right;  but  these  authors 
have  been,  almost  without  exception,  medical  men,  and 
their  opinion,  except  so  far  as  supported  by  adjudicated 
cases,  is  not  conclusive  in  deciding  a  question  like  the 
present.  Passing  by,  therefore,  -these  writers,  a  study 
of  the*  authorities  seems  to  establish  the  following 
propositions :  — 

In  the  first  place,  as  already  stated,  unquestionably 
medical  men  are  not,  in  this  country,  when  testifying  as 
ordinary  witnesses  to  facts  within  their  own  personal 
knowledge,  entitled  to  extra  compensation,  even  though 
their  professional  skill  may  have  enabled  them  to  ob- 


COMPENSATION.  11 

serve  such  facts  more  intelligently  ;  and  this  is  so  even 
in  those  States  allowing  extra  compensation  to  expert 
witnesses  when  called  as  experts. 

The  general  practice  is  thus  stated  by  Mr.  Greenleaf 
in  his  work  on  Evidence  :  — 

"  In  order  to  secure  the  attendance  of  a  witness  in  civil 
cases,  it  is  requisite  by  statute,  5  Eliz.  c.  9,  that  he  have 
tendered  to  him  according  to  his  countenance  or  calling,  his 
reasonable  charges." 

Under  this  statute  it  is  held  necessary  in  England 
that  his  reasonable  expenses  for  going  to  and  returning 
from  the  trial,  and  for  his  reasonable  stay  at  the  place, 
be  tendered  to  him  at  the  time  of  serving  the  subpoena  ; 
and  if  he  appears  he  is  not  bound  to  give  evidence  until 
such  charges  are  actually  paid  or  tendered,  unless  he 
resides  and  is  summoned  to  testify  within  the  weekly 
bills  of  mortality,  in  which  case  it  is  usual  to  leave  a 
shilling  with  him  upon  the  delivery  of  the  subpoena 
ticket.  These  expenses  of  a  witness  are  allowed  pursuant 
to  a  scale  graduated  according  to  his  situation  in  life. 
But  in  this  country  these  reasonable  expenses  are  settled 
by  statutes,  at  a  fixed  sum  for  each  day's  actual  attend- 
ance, and  for  each  mile's  travel  from  the  residence  of  the 
witness  to  the  place  of  trial  and  back,  without  regard  to 
the  employment  of  the  witness  or  his  rank  in  life.  The 
sums  are  not  alike  in  all  the  States,  but  the  principle  is 
believed  to  be  everywhere  the  same. 

"  In  some  States  it  is  sufficient  to  tender  to  the  witness 
his  fees  for  travel  from  his  home  to  the  place  of  trial,  and 
one  day's  attendance  in  order  to  compel  him  to  appear  upon 
the  summons;  but  in  others  the  tender  must  include  his 


12  MEDICAL  JURISPRUDENCE. 

fees  for  travel  in  returning.  Neither  is  the  practice  uniform 
in  this  country  as  to  the  question  whether  the  witness,  hav- 
ing appeared,  is  bound  to  attend  from  day  to  day  until  the 
trial  is  closed,  without  the  payment  of  his  daily  fees ;  but 
the  better  opinion  seems  to  be  that  without  payment  of  his 
fees,  he  is  not  bound  to  submit  to  an  examination. 

"In  criminal  cases  no  tender  of  fees  is,  in  general,  ne- 
cessary on  the  part  of  the  government  in  order  to  compel  its 
witnesses  to  attend,  —  it  being  the  duty  of  every  citizen  to 
obey  a  call  of  this  description,  and  it  being  also  a  case  in 
which  he  is  himself  in  some  sense  a  party.  But  his  fees  will, 
in  general,  be  finally  paid  from  the  public  treasury.  In  all 
such  cases  the  accused  is  entitled  to  have  compulsory  pro- 
cess for  obtaining  witnesses  in  his  favor." 

Ex  parte  Dement,  53  Ala.  389,  decided  in  1875,  is  a 
•well-considered  case  upon  the  question  under  consider- 
ation. In  this  case  it  was  held  that  a  physician,  like 
any  other  person,  may  be  called  to  testify  as  an  expert 
in  a  judicial  investigation,  whether  it  be  civil  or  crim- 
inal in  its  nature,  without  being  paid  for  his  testimony 
as  for  a  professional  opinion ;  and  that  upon  refusal  to 
testify  he  may  be  punished  as  for  a  contempt.  This 
case  will  repay  a  careful  perusal,  as  in  it  the  authorities 
are  well  collected  and  discussed. 

The  principle  of  the  case  of  Ex  parte  Dement  was  ap- 
proved and  followed  in  the  late  case  of  The  State  vs. 
Teipner  (S.  Ct.  Minn.),  32  N.  W.  Eep.  678,  decided 
May  6,  1887. 

In  Summers  vs.  The  State,  5  Tex.  App.  365  (1879),  it 
was  likewise  held  that,  although  a  physician  cannot  be 
compelled  to  make  an  autopsy,  yet,  having  made  it,  he 
may  be  compelled  to  testify  as  to  its  results. 


COMPENSATION.  13 

In  Illinois  the  rule  seems  to  be  settled  by  the  case  of 
Wright  vs.  Tlie  People,  112  111.  540  (1884).  In  this  case 
the  physician  having  voluntarily  stated  his  profession, 
etc.,  and  the  symptoms  of  the  plaintiff  in  a  civil  action 
for  assault  and  battery,  refused  to  answer  the  following 
question  calling  for  a  professional  opinion,  unless  his 
fee  of  $10  should  be  paid  or  secured  to  him:  — 

"  Question :  If  one  person  should  strike  another  a  heavy 
blow  on  the  head,  at  or  near  the  temple,  with  that  billy, 
would  it  or  would  it  not  be  likely  to  produce  upon  the  per- 
son receiving  such  blow  a  condition  alike  or  similar  to  that 
in  which  you  find  Jno.  Finneran." 

Upon  the  witness's  refusing  to  answer,  the  court 
below  fined  him  as  for  a  contempt,  and  the  Supreme 
Court  affirmed  the  judgment.  The  court,  however,  in 
their  opinion  do  not  go  beyond  the  case  stated,  and 
perhaps  may  rule  differently  upon  a  different  case. 

Opposed  to  these  cases  are  Buchman  vs.  The  State, 
59  Ind.  1 ;  Dills  vs.  TJie  State,  id.  15  (following  Blythe 
vs.  State,  4  Ind.  525).  In  these  cases  the  court,  upon 
general  principles,  came  to  a  conclusion  opposite  to  that 
of  ex  parte  Dement,  but  also  place  their  decision  upon 
Sec.  21  of  the  Bill  of  Eights  of  Indiana,  which  provides 
that  "No  man's  particular  services  shall  be  demanded 
without  compensation."  The  authority  of  Buchman  vs. 
State,  and  Dills  vs.  State,  is  weakened  by  the  fact  that 
two,  Biddle,  C.  J.,  and  Niblock,  J.,  of  the  five  judges 
dissented. 

In  re  Roelker,  1  Sprague,  276  (1855),  (a  nisi  prius 
case)  holds  that  the  court  will  not  compel  the  attendance 
of  an  interpreter  or  expert  who  has  neglected  to  obey 


14  MEDICAL  JURISPRUDENCE. 

a  subpoena,  unless  in  a  case  of  necessity,  and  does  not 
seem  to  be  a  direct  authority  upon  this  question. 

In  U.  S.  vs.  Howe  (U.  S.  Dist.  Ct.,  Western  Dist.  Ark., 
12  Cent.  Law  Jour.  193)  the  court  refused  to  punish  as 
for  a  contempt  a  Dr.  Bennett,  who  refused  to  testify 
unless  first  paid  a  reasonable  compensation. 

The  Hon.  Emory  Washburn,  in  discussing  this  sub- 
ject in  an  address  before  the  American  Academy  of 
Arts  and  Sciences  (1  Am.  Law  Rev.,  1866,  p.  63),  used 
the  following  language  :  — 

"  If  the  case  be  one  of  a  public  nature,  involving  the 
question  of  a  crime  of  magnitude,  where  the  public  safety 
requires  the  investigation,  the  right  to  compel  the  attendance 
of  such  witnesses  becomes  an  incident  to  the  exercise  of 
government  itself,  in  the  same  way  that  a  juror  is  obliged 
to  sacrifice  convenience  or  profit  to  render  a  public  service, 
or  the  soldier  is  called  upon  to  take  up  arms  in  defence  or 
execution  of  the  law.  It  rests  upon  the  maxim  salus  populi 
supremo,  lex." 

He  then  quotes  approvingly  the  following  from  1 
GreenL  Ev.  §  310,  note:- 

"  There  is  also  a  distinction  between  a  witness  to  facts 
and  a  witness  selected  by  a  party  to  give  his  opinion  on  a 
subject  with  which  he  is  peculiarly  conversant  from  his  em- 
ployment in  life.  The  former  is  bound  as  a  matter  of  public 
duty  to  testify  to  facts  within  his  knowledge.  The  latter  is 
under  no  such  obligation;  and  the  party  who  selects  him 
must  pay  him  for  his  time  before  he  will  be  compelled  to 
testify."  Webb  vs.  Page,  1  C.  &  K.  23. 

It  will  be  observed  upon  careful  examination  that 
nearly  all  the  authorities  holding  that  a  physician  can- 


RELATION  OF  PHYSICIAN  TO  PATIENTS.          15 

not  be  compelled  to  testify  as  an  expert  without  extra 
compensation  proceed  upon  the  authority  of  the  case  of 
Webb  vs.  Page,  supra,  or  are  influenced  by  statutory  or 
constitutional  provisions. 

According  to  the  weight  of  authority  it  seems  that  in 
those  States  where  there  is  no  statute  or  decision  set- 
tling the  question  in  favor  of  the  physician,  his  only 
prudent  course  is  to  testify  if  ordered  by  the  court  to  do 
so,  without  demanding  extra  compensation,  as  otherwise 
he  runs  the  risk  of  punishment  for  contempt. 

As  to  special  contracts  for  compensation,  they  are 
subject  to  the  limitation  that  the  contract  cannot  be 
made  conditional  upon  the  success  of  the  suit  in  which 
the  expert  is  to  testify.  A  contract  thus  conditioned  is 
against  public  policy  and  void. 

It  is  also  unlawful  for  a  physician  to  make  a  contract 
under  which  he  examines  into  the  condition  of  a  person 
injured  by  a  railway  or  other  accident  and  reports  the 
same  to  the  party  liable,  under  a  stipulation  that  his 
compensation  shall  be  proportioned  to  the  amount  re- 
covered from  the  defendant.  Such  a  contract  is  void  as 
being  against  public  policy. 

As  respects  the  Relation  existing  between  Physicians 
or  Surgeons  and  their  Patients,  the  rule  is  well  settled 
that  where  one  occupies  a  position  which  naturally  gives 
him  the  confidence  of  another  or  which  in  any  way 
gives  him  an  influence  or  an  undue  advantage  over  the 
other,  transactions  between  them  require  something 
more  to  give  them  validity  than  is  necessary  in  other 
cases.  In  such  case  where  a  physician  or  surgeon  has 
obtained  from  his  patient  any  sort  of  valuable  security 
or  property,  he  takes  upon  himself,  if  the  validity  of  the 


16  MEDICAL  JURISPRUDENCE. 

transfer  is  attacked,  the  burden  of  showing  that  no  un- 
due influence  was  exercised  by  him  over  the  patient, 
and  of  establishing  the  perfect  fairness  and  equity  of  the 
transaction ;  if  he  cannot  establish  these  facts  the  trans- 
action will  not  be  allowed  to  stand. 

In  the  case  of  DeMay  vs.  Roberts,  46  Mich.  161,  a 
physician  took  an  unprofessional  friend  with  him  to 
attend  a  case  of  confinement  when  there  was  no  emer- 
gency requiring  the  latter's  presence.  The  physician 
told  the  patient's  husband  that  he  had  brought  a  friend 
along  with  him  to  help  him  carry  his  things,  and  he 
was  accordingly  admitted.  The  patient,  on  afterwards 
discovering  the  fact,  sued  both,  and  it  was  held  that  the 
plaintiff  and  her  husband  had  a  right  to  presume  that 
the  outsider  was  a  medical  associate ;  that  in  obtaining 
admission  without  disclosing  his  true  character,  the 
defendants  were  guilty  of  deceit;  that  plaintiff  had  a 
right  to  testify  that  she  supposed  he  was  a  physician  or 
medical  assistant,  and  also  to  give  evidence  of  whatever 
may  have  been  said  at  the  time  tending  to  support  such 
supposition.  It  was  also  held  in  the  same  case  ad- 
missible to  ask  a  competent  witness  as  to  the  custom 
among  physicians  in  regard  to  calling  assistance  in 
these  cases. 


CHAPTER  It 

MEDICO-LEGAL  INSPECTIONS. 

The    Importance  of  a   Proper    Order   and   Method   as 

well  as  thoroughness  in  making  a  medico-legal  inspec- 
tion of  a  dead  body  and  its  surroundings  cannot  well  be 
over-estimated;  as,  if  done  in  an  unsystematic  or  in- 
complete manner,  it  will  not  unfrequently  defeat  rather 
than  aid  in  the  administration  of  justice.  To  use  a 
technical  expression,  the  degree  of  certainty  as  to  the 
cause  of  death  should,  when  possible,  be  "  certainty  to 
a  certain  intent  in  every  particular  ; "  that  is  to  say,  the 
examination  should  be  so  complete  and  thorough  as  not 
only  to  assign  an  adequate  cause  of  death,  but  to  nega- 
tive any  other  cause.  While  this  degree  of  certainty 
is  perhaps  not  attainable  in  many  instances,  it  is  in 
some ;  and  it  should  be  the  constant  endeavor  of  the 
medico-legal  practitioner  to  approach  as  nearly  as  possi- 
ble to  it ;  and  coroners  and  other  officers  engaged  in  the 
preliminary  examinations  necessary  for  the  detection 
and  punishment  of  crime  should  tolerate  nothing  less. 

Medico-Legal  Inspections  which  are  expected  to  come 
before  the  courts  should  be  made  by  at  least  two  prop- 
erly qualified  medical  men,  and  within  from  twenty-four 
to  forty-eight  hours  after  death,  whenever  practicable. 
When  necessary,  however,  to  advance  the  interests  of 


18  MEDICAL  JURISPRUDENCE. 

justice,  they  may  be  made  at  anytime  after  death ;  even 
putrefaction  will  not  afford  any  valid  reason  for  not 
undertaking  the  same.  They  should,  if  possible,  be 
made  by  natural  light,  as  when  made  by  artificial  light 
certain  characteristic  colors  indicative  of  poisoning 
would  probably  escape  notice.  The  body,  if  frozen, 
should  be  allowed  to  thaw  before  commencing  the  ex- 
amination, by  leaving  it  for  some  time  in  a  warm  room. 

The  surroundings  of  the  body  should  first  be  carefully 
noted,  and  if  possible  a  plan  made  locating  the  position 
of  the  body  when  first  seen,  with  reference  to  other 
surrounding  objects,  such  as  furniture,  instruments  of 
violence,  cups,  bottles,  etc.  Any  blood-stains  on  the 
person,  clothing,  or  elsewhere,  should  be  carefully 
noted ;  and  articles  likely  to  be  important  as  means  of 
evidence  should  be  marked  and  carefully  preserved  so 
as  to  be  capable  of  future  identification. 

The  body  should  be  first  examined  before  the  clothes 
are  removed ;  the  state  of  the  clothes,  whether  marked 
with  blood-stains,  etc.,  cut,  or  torn,  —  and  if  cut,  the  ex- 
act position  of  the  cuts  and  their  relation  to  the  wounds 
on  the  body,  if  any,  —  should  be  carefully  noted,  and 
the  clothes  themselves  preserved  for  use  as  evidence. 

Next,  the  attitude  and  position  of  the  limbs,  the  con- 
dition of  the  hands  and  nails  as  affording  evidence  of 
a  struggle  before  death,  should  be  noted ;  also  the  color 
and  other  characteristics  of  the  hair  on  the  head  and 
face ;  the  condition  of  the  teeth,  mouth,  and  tongue ; 
color  of  the  eyes  and  pupils;  and  the  expression  and 
color  of  the  face.  Particular  notice  should  be  taken 
whether  or  not  the  body  is  in  a  condition  of  post-mortem 
rigidity. 


MEDICO-LEGAL  INSPECTIONS.  19 

Having  completed  the  external  examination,  the 
clothes  should  be  removed;  the  body  should  then  be 
examined  as  to  its  temperature,  the  presence  of  rigidity, 
its  state  of  putrefaction  or  otherwise,  the  sex,  height,  and 
weight,  probable  age,  development,  whether  lean  or  fat, 
and  the  general  condition  of  the  body  as  to  the  state  of 
its  nourishment.  The  body  should  also  be  examined 
with  reference  to  the  color  of  the  skin,  scars,  and  marks 
thereon,  abnormities  of  structure,  and  stains,  such  as 
feces,  semen,  etc.  Careful  examination  should  be  made 
for  injuries,  such  as  contusions,  wounds,  etc. ;  if  any 
wounds  are  found,  their  nature,  depth,  direction,  and 
extent  should  be  carefully  determined.  The  condition 
of  the  edges  of  the  wounds  should  be  particularly  ex- 
amined, and  their  depth  carefully  determined,  not  by 
probing,  but  by  careful  dissection.  The  neck  should  be 
examined  to  see  if  there  are  any  marks  of  external 
violence  indicative  of  strangulation,  etc. ;  if  a  cord  is 
found  its  position  upon  the  neck  or  otherwise  should 
be  carefully  noted. 

In  examining  the  body  for  injuries,  particular  ex- 
amination should  be  made  of  all  the  inlets  and  outlets 
of  the  body.  It  should  be  remembered  that  a  fatal 
wound  may  be  inflicted  through  the  orbit,  fontanelles 
in  the  case  of  infants,  the  mouth,  vagina,  or  anus. 

If  the  subject  to  be  examined  is  an  infant,  its  length 
and  weight,  the  length  and  state  of  the  hair,  length 
and  condition  of  the  nails,  presence  or  absence  of  the 
membrana  pupillaris,  condition  of  the  genital  organs, 
the  centres  of  ossification,  the  umbilical  cord,  the  fon- 
tanelles, and  cartilages  of  the  nose  and  ears,  should  all 
be  carefully  noted. 


20  MEDICAL  JURISPRUDENCE. 

In  making  a  post-mortem  examination  a  knowledge 
of  pathological  anatomy  is  of  the  greatest  importance. 
As  has  been  well  observed  by  Virchow,  — 

"Medico-legal  technics,  with  all  due  deference  to  the 
independence  of  forensic  medicine,  will  always  go  hand  in 
hand  with  pathological  anatomy,  for  the  latter  is  more  uni- 
versal :  it  has  to  deal  with  cases  of  all  kinds,  and  for  that 
reason  is  a  great  protection  against  that  one-sideduess  with 
which  medico-legal  practice  is  so  much  encumbered." 

A  well  considered  order  of  examination  is  here  of  the 
greatest  importance ;  and  an  examination  of  the  various 
authors  upon  this  subject  reveals  a  considerable  variety 
of  methods.  Many  authors  advise  the  examination  of 
the  head  first.  Casper  recommends  opening  first  that 
cavity  in  which  there  is  the  greatest  probability  of  finding 
the  cause  of  death.  While  exceptional  cases  may  neces- 
sitate a  change  of  this  order,  the  following  scheme  fol- 
lowed by  Professor  Virchow  has  much  to  recommend  it. 
His  practice  has  for  years  been  that  "under  all  cir- 
cumstances the  abdomen  is  to  be  first  opened,  but  not 
dissected."  It  is  only  necessary  in  this  stage  to  deter- 
mine the  position  of  the  diaphragm  and  other  organs ; 
and  to  note  any  abnormal  contents  of  the  abdomen 
which  may  possibly  be  present,  and  the  color  of  the 
parts  exposed.  The  position  of  the  abdominal  viscera 
and  their  relations  should  be  determined  by  manual 
examination ;  their  color  should  be  noted,  remembering 
that  the  color  of  many  parts  is  entirely  due  to  the  blood 
and  that  in  a  dead  body  the  arterial  blood  cannot  be 
well  distinguished  from  venous  blood.  The  presence  or 
absence  of  pathological  coloring-matters,  such  as  pus 


MEDICO-LEGAL  INSPECTIONS.  21 

or  bile,  and  of  extravasations  should  be  noted.  If  any 
foreign  matters  are  found,  careful  note  of  the  same 
should  be  made.  The  presence  of  adhesions  and  other 
pathological  conditions  which  may  be  determined  without 
dissection,  should  also  be  noted.  The  position  of  the 
diaphragm  in  the  dead  bodies  of  infants  should  be  noted 
immediately  after  the  opening  of  the  abdomen. 

After  the  completion  of  this  preliminary  examination 
of  the  abdomen,  the  thorax  is  immediately  to  be  opened 
and  dissected  unless  there  is  some  cogent  reason  for 
departing  from  the  rule.  The  suspicion  of  poisoning  is 
always  admitted  to  be  a  reason  of  this  nature,  and  in 
this  case  the  whole  of  the  examination  centres  in  the 
stomach,  and  every  precaution  must  be  taken  to  place 
it  and  its  contents  without  loss  or  change  at  the  dis- 
posal of  the  law.  See  post,  TOXICOLOGY. 

In  examining  the  thorax  the  condition  of  the  pleural 
cavities  should  be  noted,  as  respects  the  position,  color, 
and  condition  of  their  contents,  and  presence  of  foreign 
bodies ;  and  this  without  cutting  any  of  the  important 
structures,  such  as  arteries,  veins,  etc. 

The  pericardium  and  heart  should  next  be  examined. 
As  observed  by  Professor  Virchow,  — 

"He  who  would  open  the  pericardium  and  dissect  the 
heart  before  determinining  whether  hsemato-thorax,  hydro- 
thorax  or  pleuritis  be  present,  is  a  man  who  ought  not  to 
undertake  a  preliminary  examination  at  all." 

The  lungs  ought  not  to  be  removed  from  the  thorax 
before  the  heart  has  been  examined,  for  this  cannot  be 
done  without  separating  the  pulmonary  arteries  and 
veins.  Before  removing  any  of  the  viscera  from  the 


22  MEDICAL  JURISPRUDENCE. 

thorax  for  more  detailed  examination,  ligatures  should 
be  placed  upon  all  the  important  vessels  connecting  the 
same  with  the  cranial  and  abdominal  cavities,  and  the 
sections  of  the  vessels  made  between  two  ligatures. 

In  the  examination  of  the  contents  of  the  thorax, 
note  any  adhesions  of  the  lungs,  —  whether  they  fill  the 
chest  as  in  emphysema,  or  are  collapsed, — the  presence 
or  absence  of  tubercular  or  other  disease,  etc.  In  the 
examination  of  the  pericardium,  note  the  presence, 
nature  as  purulent,  sero-purulent,  or  serous,  of  the  con- 
tents of  the  sac.  Note  also  the  presence  of  tumors,  if 
any,  in  the  thorax. 

In  examining  the  heart  and  vessels  note  the  size  of 
the  heart,  fulness  of  the  coronary  vessels  and  of  the 
different  cavities  of  the  heart,  weight  of  the  heart,  its 
condition  as  to  fatty  degeneration,  etc.,  hypertrophy, 
condition  of  the  valves,  etc. ;  the  condition  of  the  vessels 
whether  atheromatous  or  having  aneurisms.  As  to  the 
lungs,  note  the  color,  nature  of  the  surface,  capacity  for 
air,  character  of  the  lung  tissue,  and  of  the  fluid  they 
exude  on  pressure ;  condition  of  the  bronchial  tubes  and 
pulmonary  artery ;  the  presence  of  foreign  matter  in  the 
air  passages,  and  any  pathological  conditions  not  above 
enumerated.  The  method  of  examining  the  lungs  of 
new-born  children  will  be  considered  in  the  chapter  on 
INFANTICIDE. 

Prolonging  the  incisions  to  the  chin,  the  larynx, 
trachea,  pharynx,  resophagus,  and  the  great  vessels  of 
the  throat  should  next  be  examined. 

Eeturning  now  to  the  further  inspection  of  the  ab- 
dominal organs,  they  should,  according  to  Professor 
Virchow,  be  examined  in  the  following  order:  — 


MEDICO-LEGAL  INSPECTIONS.  23 

1.  The  Omentum.  2.  The  Spleen.  3.  The  Left  Kidney, 
Supra-Renal  Capsule,  and  Ureter.  4.  The  Right  Kidney, 
Supra-Renal  Capsule,  and  Ureter.  5.  The  Bladder,  Prostate 
Gland,  Vesiculse  Seminales,  and  Urethra,  6.  (a)  The  Testi- 
cles, Spermatic  Cord,  and  Penis;  (b)  The  Vagina,  Uterus, 
Fallopian  Tubes,  Ovaries,  and  Parametria.  7.  The  Rectum. 
8.  The  Duodenum,  Portio  Intestinalis  of  the  Ductus  Com- 
munis  Choledochus.  9.  The  Stomach.  10.  The  Hepato 
Duodena]  Ligament,  Gall-Ducts,  Vena  Portse,  Gall-Bladder, 
and  Liver.  11.  The  Pancreas,  Cceliac  (Semi-Lunar)  Ganglia. 
12.  The  Mesentery  with  its  glands,  vessels,  etc.  13.  The 
Small  and  Large  Intestine.  14.  The  Retro-Peritoneal  Lym- 
phatic Glands,  Receptaculum  Chyli,  Aorta,  Vena  Cava 
Inferior. 

After  having  completed  the  examination  of  the  tho- 
racic and  abdominal  viscera,  the  brain  and  the  spinal 
cord  should  next  be  examined.  In  examining  the  brain,  it 
may  be  necessary  in  some  cases  to  shave  the  whole  or  a 
portion  of  the  head.  Having  done  so  when  necessary,  an 
incision  should  be  made  across  the  head  from  ear  to  ear, 
and  the  scalp  reflected ;  any  injuries  to  the  scalp  should 
be  noticed,  and  the  external  surface  of  the  skull  should 
be  carefully  examined  for  fractures  or  other  injuries. 
The  skull  should  then  be  carefully  sawn  around,  about 
one-half  inch  above  the  meatus  auditorius  externus, 
and  the  calvaria  carefully  removed.  The  condition  of 
the  dura-mater,  arachnoid,  pia-mater,  the  great  longi- 
tudinal sinus,  and  the  surface  of  the  cerebral  hemis- 
pheres so  far  as  exposed,  should  be  carefully  examined 
and  described.  If  the  dura-mater  is  adherent  to  the 
skull-cap  it  may  be  divided  before  detaching  the  latter, 
and  the  skull-cap  removed  with  the  dura-mater  adher- 


24  MEDICAL  JURISPRUDENCE. 

ing  to  it,  as  otherwise  in  endeavoring  to  separate  the 
skull-cap  from  the  adherent  dura-mater  there  is  danger 
of  tearing  the  latter  and  crushing  the  brain  itself.  In 
new-born  infants  and  children  these  parts  are,  as  a  rule, 
adherent,  rendering  necessary  the  procedure  above  de- 
scribed. The  brain  should  next  be  carefully  removed, 
and  sliced  from  above  downwards,  and  examined  with 
particular  reference  to  congestions,  extravasation,  effu- 
sions, serum,  blood,  lymph,  pus,  aneurism,  embolism, 
tumors,  etc.  These  slices  should  be  thin,  as  within  the 
interior  of  a  section  five  millimetres  thick  there  is 
ample  room  for  foci  of  morbid  material  sufficient  to  pro- 
duce paralysis  or  convulsions.  The  less  is  found,  the 
greater  should  be  the  number  of  sections.  The  condition 
of  the  internal  portion  of  the  skull,  as  to  fractures,  etc., 
should  also  be  carefully  examined,  as  well  as  any  me- 
chanical injury  to  the  brain  corresponding  thereto. 

When  for  any  reason  the  brain  is  first  examined,  the 
head  should  be  raised  upon  a  block  as  high  as  can  be 
done  without  stretching  the  parts  about  the  nucha, 
and  the  head  then  opened  in  the  usual  way,  and  the 
brain  examined  in  situ.  The  head  should  be  allowed 
to  remain  in  the  same  position  till  the  condition  of  the 
abdominal  and  thoracic  organs  is  ascertained ;  or  if  low- 
ered, an  assistant  should  compress  the  vessels  at  the  base 
of  the  skull  to  prevent  any  draining  of  blood  from  the 
carotid  or  vertebral  arteries  or  jugular  veins.  For  this 
reason  it  will  usually  be  expedient  to  examine  the  ab- 
dominal and  thoracic  organs  before  the  head,  which 
with  the  spinal  cord  may  be  last  examined. 

To  examine  the  spinal  cord  and  its  membranes,  the 
vertebral  laminae  should  be  carefully  sawn  through, 


MEDICO-LEGAL  INSPECTIONS.  25 

and  the  cord  removed  with  its  dura-mater  uninjured ; 
the  external  and  internal  condition  of  the  membranes 
should  be  noted,  and  sections  made  throughout  the  en- 
tire length  of  the  cord,  and  all  injuries  and  pathological 
conditions  noted.  For  further  details  as  to  the  more 
particular  examination  of  the  separate  organs,  see  Vir- 
chow's  "  Post  Mortem  Examinations "  and  the  larger 
treatises  upon  medical  jurisprudence. 

In  making  all  of  the  above  described  examination, 
carefully  written  notes  should  be  made  as  the  work 
progresses;  particular  cases  may  render  necessary  a 
deviation  from  the  above-described  order  of  examina- 
tion, but  it  should  be  adhered  to  in  every  case  where 
there  is  no  sufficient  reason  to  the  contrary. 


CHAPTER  III. 

WOUNDS,   BURNS,  AND   SCALDS. 

The  definition  of  a  wound,  both  in  surgery  and  at  law, 
is  involved  in  considerable  confusion.  In  surgery  it  is 
usually  considered  to  mean  a  solution  of  continuity  in 
any  part  of  the  body,  suddenly  made  by  anything  that 
cuts  or  tears,  with  a  division  of  the  skin ;  by  which  some 
understand  is  meant  not  only  the  external  cutis,  but  also 
the  inward  membranes  of  the  gullet,  intestines,  bladder, 
urethra,  and  womb.  The  legal  definition  of  the  term 
"wound"  is  usually  considered  to  be  a  breach  of  the 
skin,  or  of  the  skin  and  flesh,  produced  by  external  vio- 
lence. But  the  meaning  of  the  term  is  often  modified 
by  the  context  and  the  subject  to  which  it  is  applied ; 
and  it  will  be  convenient  in  this  connection  to  include 
within  the  term  any  personal  injury  suddenly  arising 
from  any  kind  of  violence  applied  externally,  whether 
such  injury  is  external  or  internal.  It  will  also  be  con- 
venient in  this  connection  to  consider  the  subject  of 
"  Burns  and  Scalds." 

Wounds  are  classified  as  Punctured  Wounds,  In- 
cised Wounds,  Contused  Wounds,  Lacerated  Wounds, 
and  Poisoned  Wounds. 

A  punctured  wound  is  one  such  as  is  usually  caused 
by  a  pointed  instrument,  such  as  a  knife,  sword,  or 


WOUNDS,  BURNS,  AND  SCALDS.  27 

bayonet ;  and  its  depth  will  therefore  be  much  greater 
than  its  superficial  extent. 

An  incised  wound,  commonly  known  as  a  cut,  may 
be  defined  as  a  solution  of  continuity  without  loss  of 
substance,  —  such  as  is  usually  produced  by  some  cutting 
instrument  with  a  more  or  less  sharp  or  thin  edge. 

A  contused  wound  is  one  in  which  there  is  more 
or  less  bruising,  and  hence  discoloration  of  the  skin  or 
tissues  from  the  effusion  of  blood  from  small  ruptured 
vessels  into  the  surrounding  tissue. 

A  lacerated  wound  is  one  which  may  be  produced  by 
a  blunt  or  dull  instrument,  stones,  bullets,  missiles  from 
firearms,  etc.  Many  wounds  are  of  a  mixed  character, 
such  as  those  made  by  firearms  or  by  the  use  of  a  knife, 
in  which  at  times  one  part  of  the  wound  may  be  incised 
and  another  part  lacerated. 

Poisoned  wounds  may  possess  either  of  the  above 
characteristics,  with  the  addition  of  some  poisonous 
matter  introduced  therein  at  the  time  the  injury  is  in- 
flicted ;  they  are  usually  made  by  cutting  or  pointed  in- 
struments, or  by  the  stings  or  bites  of  insects,  reptiles, 
etc. 

Punctured  wounds.  In  punctured  or  penetrating 
wounds  as  above  defined,  the  margins  will  generally  not 
be  found  in  close  contact,  but  somewhat  apart,  and  the 
regularity  of  their  edges  will  vary  with  the  sharpness  of 
the  instrument  producing  them ;  when  following  thrusts 
with  instruments  properly  so  called,  they  may  usually 
be  distinguished  from  those  caused  by  glass,  crock- 
ery, nails,  etc.,  by  the  sharpness  of  their  edges,  their 
freedom  from  contusions,  and  their  amount  of  retrac- 
tion or  the  reverse ;  however  occasioned,  they  usually 


28  MEDICAL  JURISPRUDENCE. 

bleed  but  sparely,  —  unless  when  some  large  vessels  are 
divided  or  where  cavities  are  penetrated,  —  and  almost 
never  heal  by  first  intention.  They  may  be  produced 
by  any  weapon  or  other  substance  having  a  sharp  point, 
such  as  a  thin  cane,  tobacco-pipe,  arrows,  sharp  stones, 
etc.  The  solutions  of  continuity  do  not  always  take  the 
shape  of  the  instrument  by  which  they  were  produced, 
but  vary  not  only  with  the  nature  of  the  instrument, 
but  with  the  situation  or  direction  of  the  wound,  charac- 
ter of  the  tissue,  its  degree  of  tension,  etc.  The  wound 
is  seldom  as  large  as  the  instrument  which  caused  it. 
The  openings  made  in  the  clothes  before  entering  the 
body  are  in  this  class  of  wounds  generally  smaller  than 
the  instrument  producing  them.  Punctured  wounds, 
even  when  made  with  a  sharp  instrument,  are  not  al- 
ways in  the  form  of  a  straight  cut,  but  not  infrequently 
send  off  a  spur  somewhere  in  their  course  like  the  two 
lines  of  the  Greek  letter  <y. 

Incised  wounds.  Although  these  wounds  are  usually 
made  by  instruments  with  cutting  edges  more  or  less 
sharp,  they  are  not  infrequently  made  by  articles  hav- 
ing an  angle  nearly  equal  to  or  even  exceeding  90  de- 
grees ;  even  the  fist,  or  a  blunt  body  striking  a  sharp 
bony  ridge,  will  often  produce  sharply  cut,  gaping 
wounds.  The  superficial  extent  of  these  \vounds  is  usu- 
ally greater  than  their  depth,  and  they  usually  bleed 
more  freely  than  all  others.  Their  margins  are  gener- 
ally sharp,  straight,  and  well  defined.  It  is  to  be 
remarked,  however,  that  even  where  a  sharp  cutting 
instrument  is  used,  if  considerable  force  has  been  em- 
ployed it  will  sometimes  be  found  not  only  to  have 
cut,  but  also  to  have  bruised  and  lacerated  the  parts 


WOUNDS,  BURNS,  AND  SCALDS.  29 

divided.  Incised  wounds  gape  more  than  other  wounds, 
but  the  state  of  the  muscles  as  to  contraction  or  relaxa- 
tion has  considerable  influence  upon  the  size  of  the 
wound.  An  incised  flesh-wound  in  the  direction  of 
the  fibres  of  the  muscle  will  give  rise  to  little  or  no  gap- 
ing of  the  wound,  while  a  transverse  cut  will  appear 
deeper  and  will  gape  more.  It  is  not  always  possible  to 
determine  whether  an  incised  wound  was  produced  by  a 
more  or  less  blunt  body  or  a  cutting  instrument,  espe- 
cially where  from  twenty-four  to  forty-eight  hours  have 
elapsed,  and  the  wound  has  not  healed  by  first  intention. 
In  attempting  to  determine  the  kind  of  instrument 
employed,  the  condition  of  the  edges  should  be  particu- 
larly noticed ;  which,  however,  can  only  well  be  done 
while  the  wound  is  recent.  Where  the  wound  is  pro- 
duced by  a  sharp  instrument  drawn  across  the  part,  the 
edges  will  be  found  to  be  straight ;  but  if  the  instrument 
is  blunt,  or  pressure  has  been  used  upon  it  against  the 
part,  the  edge  will  be  found  more  or  less  serrated  or  ir- 
regular. In  incised  wounds  where  the  different  parts 
are  nearly  of  uniform  consistency,  the  deepest  part  of 
the  wound  is  commonly  nearer  the  commencement  than 
the  end.  At  the  commencement  of  incised  wounds, 
not  infrequently  one  or  two  slight  superficial  incisions 
have  been  made  before  the  person  was  able  to  inflict 
the  principal  wound.  The  principal  wound  frequently 
ends  in  a  bifurcation  or  in  several  points.  These  dis- 
tinctive characteristics  are  usually  more  noticeable  in 
wounds  of  the  throat ;  though  even  here  they  are  not 
invariable  in  their  occurrence  and  are  most  apt  to 
be  wanting  in  cases  of  suicidal  cut-throat  with  blunt 
instruments. 


30  MEDICAL  JURISPRUDENCE. 

In  the  case  of  homicidal  or  suicidal  wounds  in  the 
living,  the  principal  incision  is  rarely  the  only  one,  and 
the  line  of  the  incision  will  diverge  more  or  less  from 
the  straight  course  which  usually  characterizes  an  in- 
cision in  a  dead  body. 

Where  incised  wounds  are  made  through  the  cloth- 
ing, the  cuts  through  the  same  are  usually  larger  than 
the  wounds. 

As  to  the  appearance  assumed  by  incised  wounds  not 
healing  by  first  intention,  it  may  be  laid  down  as  a 
general  rule  that  during  the  first  twelve  hours  after 
their  infliction  such  wounds  will  be  bloody.  About  this 
time  inflammation  will  have  commenced,  with  secretion 
of  serosity,  which  will  continue  during  the  second  day. 
The  third  day  sero-purulent  matter  will  begin  to  exude, 
and  by  the  fourth  or  fifth  day  or  even  later,  suppura- 
tion will  be  fully  established,  which  in  a  simple  wound 
without  loss  of  substance  may  last  from  five  to  eight 
days ;  and  from  the  fifteenth  to  the  eighteenth  day  the 
wound  will  cicatrize.  This  is  the  rule  laid  down  by 
Dr.  Ogston;  but  when  the  wound  is  treated  accord- 
ing to  the  modern  system  of  aseptic  surgery  this  rule 
will  require  more  or  less  modification.  The  time  re- 
quired for  healing  will  be  considerably  lessened,  and 
there  may  be  (when  the  case  is  properly  treated)  no 
suppuration. 

The  cure  of  an  incised  wound  will,  however,  under 
ordinary  treatment,  be  influenced  very  much  by  circum- 
stances. Thus,  it  may  heal  by  first  intention  in  some 
healthy  persons,  without  any  suppuration ;  and  where 
the  subject  is  unhealthy  a  much  longer  time  may 
be  taken  in  effecting  a  cure.  The  result  may  also  be 


WOUNDS,  BURNS,  AND   SCALDS.  31 

influenced  by  the  age  of  the  party,  depth  and  locality 
of  the  wound,  and  other  circumstances. 

An  important  question  frequently  arises  in  this  con- 
nection, whether  an  incised  wound  has  or  has  not  been 
inflicted  during  life.  The  experiments  of  Orh'la  and  of 
Taylor  show  that  the  appearances  of  wounds  inflicted 
immediately  after  death  so  closely  resemble  those  of 
wounds  inflicted  immediately  before  death  as  not  to  be 
distinguishable  from  each  other ;  but  when  the  infliction 
of  the  respective  wounds  dates  either  a  few  hours  before 
or  after  death,  there  are  some  marked  appearances  by 
which  the  time  of  their  infliction  may  usually  be  deter- 
mined. Incised  wounds  made  by  sharp  instruments  on 
living  persons  usually  bleed  more  or  less  freely,  and 
the  blood  will  be  found  to  have  clotted  on  various  parts 
of  the  body,  clothes,  floor,  or  surrounding  objects.  If 
the  wound  has  not  been  interfered  with,  clots  will  be 
found  adhering  to  the  edges  or  to  the  wounded  vessels. 
The  edges  of  the  wound  will  be  found  everted,  and  the 
muscular  and  cellular  tissues  of  the  wound  effused  with 
blood.  If  the  wound  has  been  inflicted  a  few  hours 
before  death,  its  edges  will  be  found  more  or  less 
swollen,  and  if  of  small  extent,  its  lips  will  be  loosely 
agglutinated. 

If  the  wound  has  been  inflicted  some  days  it  will 
exhibit  either  signs  of  repair  or  of  destruction  of  the 
tissues.  These  may  have  healed  by  first  intention  or 
sometimes  under  cover  of  a  scab,  or  by  means  of  granu- 
lation which  involves  suppuration,  and  which  is  the 
common  method  of  healing  in  wounds  exposed  to  the 
air,  where  there  is  much  injury  to  the  parts.  The  ap- 
pearance of  these  signs  of  repair  is  of  course  proof 


32  MEDICAL  JURISPRUDENCE. 

positive  that  the  injury  was  inflicted  before  death. 
The  earliest  period  at  which  pus  will  be  found  is 
from  eighteen  to  twenty-four  hours. 

If  the  wound  was  inflicted  after  death  its  edges  will 
usually  be  found  in  close  apposition ;  there  will  be  com- 
paratively little  effusion  of  blood,  and  there  will  be  very 
little  or  no  coagula  around  the  wound,  and  of  course  no 
evidence  of  repair  or  other  vital  reactions. 

Contusions  and  contused  -wounds,  which  for  conveni- 
ence will  be  considered  together,  may  give  rise  to  effects 
of  three  sorts,  namely,  concussion,  contusion,  and  disor- 
ganization. 

As  respects  concussion,  this  effect  will  depend  upon 
the  degree  of  the  impulse,  and  the  nature  and  form  of 
the  part  struck.  The  results  of  concussion  will  differ 
according  to  the  part  of  the  nervous  system  which  is 
the  seat  of  the  injury;  thus,  concussion  of  the  brain 
may  cause  momentary  insensibility  or  death.  Concus- 
sion of  the  spine  may  produce  more  or  less  injury  to 
the  parts  receiving  their  nervous  supply  from  the  in- 
jured portion  of  the  spinal  cord.  A  stroke  over  the 
epigastrium  or  praecordia  may  by  arresting  the  heart's 
action  prove  immediately  fatal;  where  the  concussion 
proves  immediately  fatal,  death  occurs  by  syncope,  and 
not  unfrequently,  except  in  the  case  of  the  concussion 
of  the  brain,  leaves  no  traces  of  the  mode  of  its  produc- 
tion in  the  interior  of  the  body.  In  cases  of  concussion 
of  the  brain,  however,  there  will  usually  be  some  local 
injury  to  the  scalp ;  whether  such  fatal  injuries  will 
always  produce  a  visible  injury  to  the  brain  is  a  matter 
upon  which  surgical  authorities  are  in  conflict.  In  a 
case  of  concussion  of  the  spine  immediately  fatal,  there 


WOUNDS,  BURNS,  AND  SCALDS.  33 

will  usually  be  found  traces  of  the  injury,  such  as  rup- 
tures of  ligaments,  fractures  or  dislocations  of  the  verte- 
brae, extravasation  of  blood  outside  or  inside  the  cord, 
etc.  Where,  however,  the  concussion  of  the  spine  was 
not  fatal,  especially  in  cases  of  railway  accidents,  there 
is  a  great  conflict  of  opinion  as  to  whether  the  existence 
of  real  injury  can  be  with  certainty  diagnosticated  from 
malingering. 

The  term  "  contusion"  is  usually  restricted  to  injuries 
unaccompanied  by  external  wounds.  A  contusion 
strictly  so-called  involves  the  application  to  the  body 
of  sudden  pressure  accompanied  with  concussion,  or  of 
pressure  continued  for  some  time.  It  may  be  effected 
without  rupturing  the  capillaries  of  the  part  struck,  or 
it  may  involve  the  rupture  of  the  small  vessels.  In  the 
first  place  the  contusion  may  not  manifest  itself  by  any 
striking  phenomena;  the  part  struck  is  painful;  the 
meshes  of  the  tissue  of  the  skin  have  been  compressed, 
and  after  some  minutes  the  part  swells  slightly  and 
reddens,  the  redness  and  swelling  disappearing  in  from 
twenty-four  to  thirty-six  hours,  leaving  no  trace  of  the 
injury ;  but  if  at  the  time  of  the  receipt  of  such  contu- 
sion death  supervenes  from  some  other  cause,  the  part 
struck  undergoes  by  evaporation  a  loss  of  its  fluids,  and 
the  skin  becomes  dried,  brown,  and  hard,  presenting 
much  the  appearance  of  parchment ;  which  last  effect, 
however,  may  be  as  readily  produced  on  the  dead  as  on 
the  living,  and  will  be  further  considered  hereafter. 

Where  the  stroke  has  involved  the  rupture  of  the 
capillaries  the  contusion  will  be  accompanied  by  ecchy- 
mosis  or  infiltration  of  blood  into  the  areolar  tissue  of 
the  part.  When  such  ecchymosis  is  superficial,  as  is 

3 


34  MEDICAL  JURISPRUDENCE. 

usually  the  case,  the  skin  soon  becomes  of  a  blackish  or 
deep  violet  color ;  later  this  color  succeeds  to  a  bluish 
color ;  this  in  turn  becomes  green ;  the  green  becomes 
yellow ;  and  the  yellow  is  finally  succeeded  by  the  natu- 
ral color  of  the  skin,  —  these  phenomena  occupying  a 
space  of  several  days.  As  a  general  rule,  the  blue  color 
appears  about  the  second  day ;  the  green  from  the  fifth 
to  the  sixth  ;  the  yellow  from  the  seventh  to  the  eighth ; 
and  the  color  entirely  disappears  from  the  tenth  to  the 
twelfth  day,  or  even  later.  Ecchymosis  may  not  in- 
volve the  skin  at  all,  but  may  be  confined  to  the  subcu- 
taneous areolar  tissue,  in  which  case  the  discoloration  of 
the  skin  will  not  appear  till  from  thirty-four  to  thirty- 
six  hours,  or  even  later.  Ogston  describes  a  case  in 
which  ecchymosis  did  not  appear  till  the  expiration  of 
four  days  after  the  infliction  of  the  blows.  In  some 
cases  where  the  ecchymosis  exists  deep  among  the 
muscles  of  the  limb,  it  will  not  be  noticed  at  all  till  at 
the  end  of  forty,  fifty,  or  sixty  days,  when  irregular  yel- 
lowish-green or  bluish  spots  appear  over  the  injured 
part.  It  should  be  remembered  that  the  ecchymosis 
does  not  constantly  appear  at  the  situation  the  seat  of  the 
contusion  would  indicate ;  and  that  it  may  sometimes 
proceed  from  other  causes  than  violence,  such  as  scurvy, 
purpura  hoemorrhagica,  strong  muscular  effort,  etc. 

It  is  often  important  to  determine  whether  contu- 
sions have  been  inflicted  before  or  after  death.  When 
inflicted  two  or  three  hours  before  death  the  change  of 
color  produced  cannot  be  confounded  with  any  ordinary 
post-mortem  appearance ;  and  besides,  the  swelling  and 
extravasation  of  blood  into  the  cellular  tissue  will  ordi- 
narily afford  conclusive  evidence  of  the  ante-mortem 


WOUNDS,  BUENS,  AND  SCALDS.  35 

nature  of  the  injury ;  but  where  the  strokes  are  inflicted 
shortly  after  death  there  is  more  difficulty,  as  it  has  been 
proved  by  experiment  that  some  strokes  inflicted  shortly 
after  death  produce  marks  which,  so  far  as  color  is  con- 
cerned, do  not  differ  from  the  effects  of  blows  during  the 
last  moments  of  life.  Swelling  of  the  parts  and  coagula- 
tion of  the  blood  effused  into  the  subjacent  cellular  tissue, 
with  the  incorporation  of  blood  with  the  whole  thick- 
ness of  the  true  skin,  rendering  it  black  instead  of  white 
and  increasing  its  firmness  and  resistance,  may  be  con- 
sidered as  strong  if  not  conclusive  evidence  that  the 
blows  were  inflicted  during  life. 

The  co-existence  of  a  wound  with  the  contusion  does 
not  much  affect  the  character  of  the  latter  injury ;  in 
this  case,  however,  there  may  be  hemorrhage  in  the  sur- 
rounding tissues ;  much  blood  rarely  escapes  outwardly. 
Wounds  of  this  class,  unless  over  the  cranium,  are  char- 
acterized by  uneven  and  irregular  edges,  and  less  acute 
angles,  and  are  in  general  too  characteristic  to  require 
description.  The  disorganization  of  the  parts  struck, 
which  may  be  one  of  the  consequences  when  struck 
with  a  blunt  body,  and  which  is  termed  "attrition," 
differs  both  from  contusion  and  laceration  in  that  here 
the  structure  is  more  or  less  completely  destroyed  and 
broken  down ;  attrition  is  necessarily  followed  by  ecchy- 
mosis,  —  the  broken-down  tissue  forming  a  cavity  for 
the  effused  blood,  which  presents  the  characteristics  of 
a  tumor  with  fluctuation. 

The  most  serious  injuries  resulting  from  contusions  are 
lacerations  of  internal  organs,  and  ruptures  of  blood-ves- 
sels and  other  deep-seated  parts  ;  such  injuries,  however, 
rarely  follow  common  assaults  with  the  fist  or  even  with 


36  MEDICAL  JURISPRUDENCE. 

sticks  or  stones,  unless  the  blows  are  inflicted  about  tlie 
head.  The  serious  injuries  referred  to  more  commonly 
arise  from  falls  from  a  height,  the  fall  of  heavy  bodies 
upon  the  person,  or  from  railway  accidents.  Ruptures 
of  viscera  are  more  common  in  the  case  of  those  organs 
which  are  naturally  voluminous  and  easily  displaced, 
such  as  the  liver,  kidneys,  and  spleen;  and  are  more 
rare  in  the  case  of  the  heart,  lungs,  brain,  bladder,  and 
alimentary  canal.  Internal  arteries  and  veins,  when 
healthy,  except  those  within  the  cranium  and  spinal 
canal,  are  not  commonly  injured  by  outward  shocks. 
It  must  be  remembered  that  ruptures  of  the  heart  are 
occasionally  produced  in  certain  diseased  states  of  the 
organ,  such  as  attenuation  and  aneurism  of  its  walls, 
and  it  must  also  be  remembered  that  spontaneous  rup- 
tures of  the  heart  sometimes  occur  which  cannot  be  cer- 
tainly referred  either  to  injury  or  disease.  Ruptures  of 
the  cerebral  mass  from  violence  are  believed  to  be  ex- 
tremely rare;  in  drunken  quarrels  and  fights  sponta- 
neous ruptures  of  the  cerebral  vessels  are  not  uncommon, 
and  ruptures  of  the  larger  blood-vessels  within  other 
cavities  of  the  body  are  not  unusual  consequences  of 
heavy  falls.  The  larger  veins  may  also  be  ruptured 
from  violence,  and  may  burst  suddenly  when  weakened 
by  previous  disease.  For  details  of  these  interesting 
cases  the  student  is  referred  to  larger  standard  works 
on  medical  jurisprudence,  the  limits  assigned  to  this 
work  preventing  their  full  discussion  here. 

Lacerated  "Wounds.  Lacerated  wounds,  which  are 
produced  by  tearing  instead  of  cutting,  are  attended 
with  complete  separation  of  the  edges,  and  there  is 
always  more  or  less  thickening  of  their  margins  from 


WOUNDS,  BURNS,  AND   SCALDS.  37 

the  bruising  of  their  edges.  In  this  respect  they  some- 
what resemble  contused  wounds,  from  which,  however, 
they  may  usually  be  distinguished  by  the  shreddiness 
and  irregularity  of  their  margins.  Such  wounds  are 
remarkable  for  the  want  of  correspondence  between  the 
quantity  of  blood  lost  and  the  importance  and  vascular- 
ity  of  the  injured  parts.  They  are  frequently  attended 
with  marks  of  contusion,  and  there  may  be  clotted  blood 
effused  in  their  vicinity.  It  is  only  when  these  appear- 
ances are  present  that  a  confident  opinion  can  be  given 
as  to  their  having  been  produced  during  life. 

Gun-shot  wounds  may  be  considered  in  this  connec- 
tion. These  wounds  partake  of  the  character  of  contused 
wounds,  with  more  or  less  laceration,  and  occasionally 
exhibit  the  appearance  of  burns.  They  bleed  sparingly, 
if  at  all ;  their  margins  are  round  and  thickened ;  the 
bottom  of  the  wound  is  reddish  brown,  the  surrounding 
parts  ecchymosed  and  occasionally  blackened.  In  the 
living  they  are  usually  attended  with  more  or  less  in- 
sensibility of  the  parts  struck,  and  the  following  inflam- 
mation is  usually  extensive  and  severe.  When  the 
projectile  has  passed  through  a  portion  of  the  body, 
as  a  general  thing  the  entrance  wound  will  be  smaller 
than  the  exit  wound,  —  the  edges  of  the  entrance  will  be 
depressed  and  contused ;  the  edges  of  the  exit  project- 
ing and  torn.  The  entrance  wound  will  be  dry  and 
dark-colored ;  the  exit  wound  raw  and  bloody.  There 
will  be  loss  of  substance  in  the  former,  but  none  in  the 
latter  as  a  general  rule.  Such  is  the  description  usually 
given  of  gun-shot  wounds  by  writers  upon  medical  ju- 
risprudence and  surgery.  It  should  be  remembered  that 
substances  of  very  low  degree  of  density,  such  as  plugs 


38  MEDICAL  JURISPRUDENCE. 

of  tallow,  light  wood,  cork,  wads  of  paper,  and  the  like, 
will,  if  sufficient  velocity  be  impressed  upon  them,  serve 
to  inflict  penetrating  wounds  into  the  denser  parts  of 
the  body,  having  all  the  characteristics  of  wounds  in- 
flicted by  projectiles.  The  effects  produced  by  bullets, 
however,  vary  with  the  shape  and  speed  of  the  projec- 
tile. Where  the  wound  is  produced  by  a  rifle-ball  at 
full  speed,  the  above  description  of  the  wound  is  be- 
lieved to  be  correct.  As  the  distance  from  the  weapon 
increases  and  the  velocity  of  the  ball  diminishes,  the 
wound  of  entrance  will  become  less  circular  and  regular, 
and  larger  and  more  contused,  —  the  wound  sometimes 
consisting  of  three  triangular  flaps,  which  on  lifting  up 
can  be  made  to  meet  at  their  apices  in  the  centre  of  the 
opening.  Bullets  at  full  speed  perforate  or  penetrate ; 
at  lessened  speed,  crush  and  lacerate.  When  a  dis- 
charge takes  place  very  near  the  body  the  injured 
tissues  will  be  more  or  less  scorched,  blackened  and 
studded  with  grains  of  powder;  and  the  entrance 
wound  larger,  ragged,  and  excavated.  With  the  rifle- 
ball  the  course  is  more  frequently  direct  than  with  that 
from  the  old  smooth-bore  musket,  although  tortuous 
courses  are  even  now,  though  less  frequently,  met  with. 
Modern  projectiles  are  said  to  cause  less  severe  injury 
of  the  soft  parts  than  the  old  spherical  balls.  The  in- 
jury imparted  to  soft  parts  by  what  are  called  spent 
balls  and  by  ricochet  shots  are  the  most  destructive ; 
and  larger  projectiles  rolling  over  the  surface  of  the 
part  or  moving  at  a  low  rate  of  speed,  possess  a  force 
which  will  often  crush  all  parts  with  which  they  hap- 
pen to  come  in  contact.  The  character  of  the  wound 
may  also  be  modified  somewhat  by  the  hardness  of  the 


WOUNDS,  BURNS,  AND   SCALDS.  39 

ball,  and  its  change  of  shape  in  consequence  of  striking 
against  a  large  bone.  In  such  cases  the  size  of  the  exit 
wound  will  be  very  much  increased.  The  wound  pro- 
duced by  the  so-called  "  express  bullet,"  in  which  the  ball 
is  light,  has  a  concavity  at  its  point,  and  is  driven  by  a 
very  large  charge  of  powder,  possesses  the  characteristic 
last  mentioned  in  a  most  remarkable  degree,  even  where 
the  ball  has  not  come  in  contact  with  any  bone.  An 
express  ball  after  penetrating  the  body  will  usually  ex- 
pand and  fly  into  many  pieces,  greatly  lacerating  the 
internal  organs  and  producing  great  shock,  much  greater 
than  if  the  ball  had  passed  entirely  through  the  body  in 
its  original  shape.  The  medical  jurist  will,  however, 
rarely  have  occasion  to  give  an  opinion  upon  wounds 
produced  by  this  sort  of  projectile. 

A  charge  of  fine  shot  fired  at  a  short  distance  will 
often  produce  nearly  the  same  effect  as  that  of  a  large 
solid  ball ;  even  the  explosion  of  powder  alone  without 
ball  or  wadding,  at  a  very  short  distance,  is  capable  of 
producing  very  severe  injuries  or  even  death.  It  should 
be  remembered,  however,  that  a  loaded  pistol  fired  off 
with  the  muzzle  firmly  pressed  against  the  body  will 
probably  burst  or  recoil  without  seriously  injuring  the 
person  against  whom  it  is  fired.  The  statement  made 
at  the  beginning  of  this  subject,  that  the  entrance  wound 
is  commonly  smaller  than  the  exit  wound,  is  denied  by 
some  authors,  and  perhaps  under  some  circumstances 
may  require  qualification ;  but  in  our  judgment  it  is 
the  better  opinion. 

The  opening  made  by  a  ball  in  penetrating  the  clothes 
is  always  smaller  than  that  made  in  the  skin  below  them. 

In  this  connection  the  question  is  sometimes  raised  as 


40  MEDICAL  JURISPRUDENCE. 

to  whether  it  is  possible  to  determine  from  inspection  of 
the  weapon  the  period  which  has  elapsed  since  it  was 
last  discharged.  It  has  been  found  that  when  the  com- 
bustion of  the  powder  has  been  imperfect,  the  inside  of 
the  barrel  of  the  weapon  near  its  muzzle  is  either  found 
blackened  by  a  coating  of  charcoal  and  sulphide  of  po- 
tassium shortly  after  the  discharge,  —  or  where  the  com- 
bustion has  been  perfect,  whitened  by  a  crust  of  sulphate 
and  carbonate  of  potash, — while  after  an  interval  of 
some  days,  varying  with  the  amount  of  moisture  in  the 
atmosphere,  the  mixed  residue  of  charcoal  and  sulphide 
of  potassium  has  become  converted  into  sulphate  of 
potash,  which  after  a  little  longer  interval  has  been 
found  to  contain  peroxide  of  iron.  These  results,  how- 
ever, might  vary  with  the  state  of  the  weather,  nature 
of  the  powder,  and  the  completeness  of  the  combustion 
to  such  an  extent  that  in  our  judgment  very  little  re- 
liance can  in  most  cases  be  placed  on  any  conclusions 
drawn  from  the  appearance  of  the  weapon. 

Any  one  of  the  above  previously  described  wounds 
may  be  also  a  poisoned  wound ;  but  wounds  of  this  de- 
scription will  rarely  come  under  the  notice  of  the  med- 
ical jurist. 

Burns  and  Scalds  may  be  conveniently  considered 
together.  A  burn  is  caused  by  the  application  of  con- 
centrated dry  heat  to  the  body ;  a  scald  by  the  appli- 
cation of  a  hot  or  boiling  liquid.  As  a  rule,  scalds  are 
less  severe  accidents  than  burns,  because  water,  being 
the  ordinary  fluid  through  which  the  scald  is  produced, 
is  never  hotter  than  212°  Fahrenheit;  yet  when  any 
other  chemical  compound  is  the  scalding  medium,  the 
effect  may  be  as  bad  as  of  the  worst  burns. 


WOUNDS,  BURNS,  AND  SCALDS.  41 

Molten  metals  produce  burns  which  can  hardly  be 
distinguished  from  those  caused  by  solid  bodies.  Boil- 
ing oils  produce  burns  as  severe  in  their  general  char- 
acteristics —  and  so  far  as  destruction  of  parts  is  con- 
cerned, in  their  effects  —  as  hot  solids  or  melted  metals. 

Boiling  water  may  produce  merely  an  inflammatory 
redness ;  in  severe  scalds,  however,  the  skin  is  commonly 
soddened,  desiccated,  and  of  an  ashy-gray  color,  scarcely 
distinguishable  from  slight  burns  from  other  causes. 
Boiling  water  never  produces,  however,  blackening  of 
the  cuticle  nor  charring  nor  desiccation  of  the  parts. 

Burns  from  acids  are  more  properly  considered  in 
another  connection.  It  may  be  stated  here,  however, 
that  nitric  or  hydro-chloric  acid  stains  are  yellow,  while 
sulphuric  acid  stains  are  brown,  and  that  the  eschars 
are  soft  and  not  hard  as  in  ordinary  burns  ;  such  burns 
are  not  surrounded  by  reddened  skin,  as  in  the  case  of 
those  produced  by  heat 

According  to  Dupuytren  there  are  six  degrees  of 
burns : — 

In  the  first  degree  there  is  mere  redness  and  tender- 
ness of  the  surface,  and  after  a  few  hours  these  symp- 
toms may  abate,  with  possibly  some  desquaination  of 
the  cuticle. 

In  the  second  degree  there  is  inflammation,  manifesting 
its  presence  by  the  effusion  of  serum  beneath  the  cuticle, 
forming  a  blister. 

In  the  third  degree  the  superficial  layer  of  the  true 
skin  is  destroyed,  the  surface  appearing  of  a  gray,  yel- 
lowish, or  brown  color,  not  painful  unless  roughly  han- 
dled. The  vesicles  that  exist  contain  a  blood-stained  or 
brown  fluid.  The  papillae  of  the  skin  with  its  nerves 


42  MEDICAL  JURISPRUDENCE. 

are  first  destroyed,  but  in  the  course  of  a  day  or  so  the 
dead  surface  is  shed  and  the  nerves  exposed,  when  the 
pain  becomes  very  severe. 

In  the  fourth  degree  the  whole  thickness  of  the  skin 
is  destroyed,  with  more  or  less  of  the  subcutaneous  cel- 
lular tissue,  the  parts  being  converted  into  a  hard,  dry, 
and  insensible  eschar  mottled  with  blood.  The  skin 
surrounding  the  eschars  may  be  blistered,  but  where  it 
comes  in  contact  with  the  injured  part  it  will  be  drawn 
into  folds  from  the  contraction,  owing  to  the  drying  of 
the  burnt  integument. 

In  the  fifth  degree  the  skin  with  the  deeper  parts  are 
involved,  —  a  black,  brittle,  charred  mass  taking  the 
place  of  healthy  tissue. 

In  the  sixth  degree  the  whole  thickness  of  the  limb 
is  carbonized. 

Death  following  burns  may  take  place  in  two  differ- 
ent ways :  from  the  depression  of  the  nervous  system, 
owing  to  the  number  of  cutaneous  nerves  affected ;  or 
later,  from  the  inflammatory  reaction  involved,  exten- 
sive suppuration,  and  hectic  fever. 

Medico-legal  questions  in  this  connection  usually 
arise  where  fire  has  been  subsequently  applied  to  the 
corpse  to  conceal  murder.  According  to  Christison,  the 
most  immediate  effect  of  the  application  of  heat  to  the 
living  body  is  a  blush  of  redness  around  the  burnt  part, 
removable  by  gentle  pressure,  disappearing  in  no  long 
time,  and  not  permanent  after  death.  Following  this 
almost  immediately,  is  a  narrow  line  of  deep  redness 
separated  from  the  burnt  part  by  a  stripe  of  dead  white- 
ness (bounded  towards  the  white  stripe  by  an  abrupt 
line  of  demarcation),  passing  at  its  outer  edges  by 


WOUNDS,  BURNS,  AND   SCALDS.  43 

different  degrees  into  the  diffused  blush,  but  not  capa- 
ble of  being  removed  like  it  by  moderate  pressure.  The 
phenomenon  which  follows  these  is  the  appearance  of 
blisters,  which,  when  the  agent  is  a  scalding  fluid,  gen- 
erally appear  in  a  very  few  minutes  in  the  living,  or 
may  be  delayed  for  hours  when  the  scalds  are  extensive, 
as  in  young  children ;  while,  when  the  agent  is  an  in- 
candescent body,  this  appearance  is  not  of  such  an 
invariable  occurrence,  though  often  observed  very  soon 
after  an  ordinary  burn,  caused  by  the  clothes  catching 
fire. 

A  line  of  redness  near  the  burn,  not  removable  by 
pressure,  and  blisters  filled  with  serum  are  considered 
by  Christison  as  certain  signs  that  the  burn  was  inflicted 
during  life.  The  absence  of  these  appearances,  however, 
is  said  by  Dr.  Taylor  not  to  point  with  certainty  to  the 
opposite  conclusion.  Dr.  Ogston  agrees  with  the  above 
conclusions  of  Christison  and  Taylor,  with  the  qualifica- 
tion that  we  must  take  into  account  not  only  the  occa- 
sional failure,  under  certain  circumstances,  of  vesication 
after  vital  burns,  but  also  the  non-occurrence  in  some 
instances  of  the  redness  of  the  burnt  part;  and  in  the 
second  place,  that  vesication  without  accompanying  red- 
ness on  a  dead  body,  would  not  authorize  the  conclusion 
that  the  burn  had  been  caused  during  life,  as  such  blis- 
ters are  met  with  from  pemphigus  in  the  living,  and  in 
the  corpse  from  the  progress  of  putrefaction. 

Where  a  body  is  more  or  less  completely  consumed, 
the  sex  may  sometimes  be  distinguished  by  the  pelvis, 
and  the  age  from  the  bones  or  teeth.  In  case  of  death 
from  burns  it  frequently  happens  that  there  are  no  char- 
acteristic post-mortem  appearances ;  fluid  in  more  than 


44  MEDICAL  JURISPRUDENCE. 

usual  quantity  will  frequently  be  found,  however,  in  the 
ventricles  and  at  the  base  of  the  brain ;  also  effusions 
into  the  serous  cavities.  The  bronchial  tubes  and  lungs 
generally  are  usually  congested,  as  well  as  the  stomach 
and  alimentary  canal.  Perforating  ulcers  of  the  duo- 
denum are  common,  especially  in  children  and  young 
people ;  the  heart  is  sometimes  found  empty,  but  more 
often  the  right  'side  is  full  and  the  left  empty.  The 
brain,  liver,  kidneys,  and  pelvic  organs  are  frequently 
congested. 

Fractures.  The  subject  of  fractures  may  be  conven- 
iently considered  in  this  connection.  It  should  be  re- 
membered that  they  do  not  always  arise  from  external 
violence,  but  are  sometimes  caused  by  violent  muscular 
action,  or  in  diseased  conditions  of  the  bone  by  ordinary 
muscular  action.  Such  injuries  sometimes  occur  spon- 
taneously in  the  foetus  in  utero  and  are  sometimes  occa- 
sioned during  delivery;  it  also  occasionally  happens 
that  blows  or  falls  of  no  great  severity  will  cause  frac- 
tures of  a  severe  or  fatal  kind,  only  admitting  of  expla- 
nation by  attention  to  the  surrounding  circumstances. 

As  to  whether  the  fractures  were  produced  during 
life,  the  only  test  which  can  be  relied  upon  with  confi- 
dence is  the  commencement  of  the  reparative  process  ; 
the  presence  of  coagulated  blood  between  the  ends  of 
the  fractured  bones  is  not  conclusive. 

In  rare  cases  the  degree  of  violence  received,  or  the 
character  of  the  instrument  by  which  it  has  been  in- 
flicted, can  be  determined  from  inspection  of  the  frac- 
tured bone. 

The  subject  of  blood  stains  will  be  considered  in 
another  chapter. 


WOUNDS,  BURNS,  AND   SCALDS.  45 

The  prognosis  of  wounds  is  a  subject  which  will 
occasionally  demand  the  attention  of  medical  jurists. 

1.  Prognosis  of  injuries  to  the  nervous  system. 
Wounds  of  the  head  are  important  chiefly  from  their 
liability  to  disturb  the  functions  of  the  brain  or  to 
involve  it  in  active  disease.  When  strictly  local  they 
heal  without  much  trouble,  but  are  liable  to  be  com- 
plicated with  diffuse  abscess,  erysipelas  or  irritative 
fever.  When  the  irritation  arising  from  such  wounds 
is  considerable,  the  brain  and  its  membranes  may  sym- 
pathize, or  the  party  be  attacked  with  tetanus,  and 
in  this  way  an  injury  apparently  inconsiderable  may 
prove  unexpectedly  fatal.  Contusions  of  the  head  are 
generally  not  dangerous  if  unattended  with  symptoms 
denoting  concussion.  Punctures  or  any  simple  frac- 
tures of  the  bones  of  the  head,  when  the  brain  is  not 
injured,  are  not  in  general  followed  by  bad  conse- 
quences, although  a  guarded  prognosis  should  be  given 
in  every  such  case.  Effusion  of  blood  within  the 
cranium  is  a  very  common  cause  of  death  from  vio- 
lence producing  concussion  of  the  brain,  even  when 
there  is  no  external  mark  of  injury  on  the  head.  The 
question  in  such  cases  arises  whether  the  effusion  is 
due  to  violence  or  to  disease;  such  effusions,  when 
spontaneous,  are  most  usual  in  the  substance  of  the 
brain,  while  if  due  to  violence  they  are  commonly  on 
the  surface  or  between  the  brain  and  the  skulL 

Injuries  to  the  spinal  cord  which  wound,  divide, 
compress,  or  disorganize  any  part  of  it,  generally  prove 
fatal  either  immediately  or  after  a  longer  or  shorter 
period.  Injuries  to  the  medulla  oblongata  are  instantly 
fatal  in  consequence  of  the  immediate  cessation  of  res- 


46  MEDICAL  JURISPRUDENCE. 

piration  and  circulation ;  it  is  important,  therefore,  in  all 
such  cases  that  the  spine  be  carefully  examined  after 
death. 

2.  Injuries  to  the  circulatory  system  are  common 
causes  of  death,  which  may  arise  either  from  exhaustion, 
due  to  hemorrhage  or  otherwise,  or  by  the  pressure  of 
the  effused  blood  impeding  the  functions  of  the  vital 
organs,  such  as  the  brain,  spinal  cord,  heart,  or  lungs. 
The  amount  of  blood  which  may  be  lost  without  de- 
stroying life  varies  with  the  different  states  of  the  consti- 
tution, and  the  habits  of  the  party.  The  proofs  of  death 
from  hemorrhage  are  such  as  indicate  that  the  wounds 
were  inflicted  during  life,  the  absence  of  blood  in  the 
larger  vessels  and  important  viscera,  and  the  healthy 
state  of  the  principal  organs  of  the  body. 

Life  may  be  immediately  destroyed  by  the  admission 
of  air  into  the  veins  through  a  wound. 

Wounds  of  the  neck  severing  the  large  vessels,  in 
the  absence  of  surgical  assistance  are  immediately  fatal; 
and  even  with  such  assistance  they  are  usually  fatal. 

Wounds  of  the  chest  most  frequently  cause  death 
by  syncope  from  hemorrhage,  but  a  less  effusion  may 
destroy  life  by  compression  of  the  heart  or  lungs. 
Ruptures  of  the  heart  or  larger  vessels  within  the 
chest  may  occur  either  from  pressure  or  from  a  blow, 
without  any  appearance  of  external  injury.  They  may 
also  occur  spontaneously  from  disease. 

Wounds  of  the  organs  of  generation  are  occasionally 
fatal  when  no  large  vessels  have  been  divided,  such  as 
incisions  on  the  inner  side  of  the  labia,  nymphre,  or 
vagina.  There  are  recorded  instances  in  which  a  nearly 
fatal  hemorrhage  has  been  caused  by  coitus. 


WOUNDS,  BURNS,  AND   SCALDS.  47 

3.  The   most  important  injuries   of  the   respiratory 
system  are  of  the  chest  and  lungs.     Contusions,  and 
fractures  of  the  ribs,  wounds  of  the  pleurae  and  lungs, 
may  prove  fatal  from  shock  or  asphyxia.     In  penetrating 
wounds  of  the  chest,  the  entrance  of  the  air  may  cause 
collapse  of  the  lungs  and  death  by  asphyxia.     Wounds 
laying  open  the  larynx  and  trachea,  while  not  neces- 
sarily fatal,  may  cause  death  by  asphyxia  from  the  blood 
obstructing  the  air  passages,  or  from  fluid  swallowed 
passing  into  the  larynx  and  causing  suffocation. 

4.  Injuries  of  the  abdomen  may  prove  fatal  by  shock, 
hemorrhage,  inflammation,  or  by  interference  with  the 
nutrition  of  the  body.     It  should  be  remembered  that 
spontaneous  ruptures  of  some  parts  of  the  bowels  may 
sometimes  occur  and  cause  sudden  death. 

The  prognosis  of  an  injury  may  be  modified  by  age, 
sex,  and  constitutional  peculiarities ;  thus  in  some  per- 
sons the  bones  are  so  thin  and  brittle  as  to  be  easily 
fractured  by  slight  blows  or  falls.  In  what  is  known 
as  the  hemorrhagic  diathesis,  dangerous  or  even  fatal 
hemorrhage  may  follow  a  trifling  blow  or  cut. 

In  the  medico-legal  inspection  where  death  has  been 
caused  by  wounds,  there  are  some  points  needing  special 
attention.  The  nature  of  the  wound,  whether  recently 
inflicted,  whether  inflicted  during  life  or  after  death, 
should  if  possible  be  carefully  determined.  Any  weapon 
found  should  be  carefully  compared  both  with  the 
clothes  and  the  external  wound,  and  foreign  bodies  (if 
any)  found  in  the  wound  should  be  carefully  preserved. 
The  length,  breadth,  and  depth  of  the  wound  should  be 
measured,  and  its  situation  and  direction  carefully  noted. 
The  probable  manner  of  infliction  and  the  degree  of  force 


48  MEDICAL  JURISPRUDENCE. 

and  the  weapon  employed  may  often  be  ascertained 
from  the  nature  and  extent  of  the  wound.  The  ques- 
tion as  to  whether  death  has  been  the  result  of  accident, 
suicide,  or  homicide,  may  sometimes  be  determined  from 
the  above  circumstances.  The  manner  of  dissecting  the 
wound  requires  careful  attention.  For  this  purpose  a 
circular  incision  should  be  carried  around  the  wound, 
three  or  four  inches  from  it  and  not  interfering  with 
it,  and  the  integument  and  underlying  structures  suc- 
cessively dissected  off,  from  the  circumference  to  the 
centre;  in  this  way  the  relations  of  the  parts  impli- 
cated, and  the  direction  and  extent  of  the  wound  may 
be  accurately  determined.  The  general  dissection  of 
the  body  may  then  be  completed  in  accordance  with 
directions  given  in  a  previous  chapter. 


CHAPTEE  IV. 

THE  SIGNS,  MODES,   CAUSES,  ETC.,   OF  DEATH. 

BY  somatic  death,  or  the  death  of  the  body  as  a 
whole,  is  meant  the  cessation  of  the  vital  functions, 
and  of  the  general  renewal  of  tissue  consequent  on 
such  cessation. 

By  molecular  death,  which  may  be  either  partial  or 
complete,  is  meant  the  death  of  a  part,  tissue,  or  organ, 
without  the  general  stoppage  of  the  circulation.  The 
part  thus  affected  becomes  obedient  to  the  operation 
of  the  ordinary  chemical  and  physical  agencies  govern- 
ing the  inorganic  molecule. 

The  signs  of  death  are  — 

1.  The  entire  and  continuous  cessation  of  the  heart's 
action.  This  cannot  be  certainly  determined  by  the 
mere  absence  of  pulsation  at  the  wrist.  In  order  to 
decide  this  question  an  examination  both  by  ausculta- 
tion and  palpation,  in  a  perfectly  quiet  room,  are  neces- 
sary ;  and  this  examination  should  include  not  merely 
the  regions  of  the  heart  proper,  but  of  the  chest  gener- 
ally, and  a  positive  conclusion  should  not  be  announced 
until  after  careful  auscultation  for  two  or  three  hours, 
at  intervals  of  fifteen  minutes;  for  recovery  has  been 
known  to  take  place  after  the  heart  has  apparently 

4 


50  MEDTCAL  JURISPRUDENCE. 

ceased  beating  for  the  period  of  fifteen  minutes.  The 
auscultation  is  better  made  with  a  good  stethoscope 
than  with  the  naked  ear.  In  addition  to  palpation  and 
auscultation,  fine  chest  movements  may  be  detected  by 
certain  mechanical  tests,  such  as  sticking  needles  with 
little  paper  flags  on  their  blunt  ends  into  the  skin,  or 
placing  small  pieces  of  cotton  wool  drawn  into  finely 
pointed  cones  about  two  inches  in  length,  over  the 
region  of  the  heart,  and  of  the  great  vessels  of  the  neck ; 
the  room  meanwhile  must  be  kept  perfectly  still  and 
free  from  draughts. 

Another  test  is  the  placing  of  a  ligature  tightly 
around  a  limb  of  the  body,  such  as  the  finger,  or 
around  the  lobe  of  the  ear.  The  part  beyond  the  con- 
striction will,  if  the  person  is  alive,  become  bright  red ; 
the  tint  gradually  increasing  in  depth  until  it  finally 
assumes  a  uniform  bluish-red  color.  At  the  spot 
where  the  ligature  is  applied  a  narrow  white  ring  will 
become  visible.  There  will  be  no  change  if  the  person 
is  dead. 

Again,  if  the  person  has  been  dead  some  hours,  no 
blood  will  flow  upon  scarification  and  application  of  a 
cupping-glass. 

Again,  if  during  life  clean  and  bright  needles  are 
thrust  into  the  muscles,  the  steel  will  quickly  oxidize 
and  tarnish ;  but  after  death  the  needles  may  remain  in 
the  flesh  an  hour  without  such  oxidation. 

A  superficial  artery  may  also  be  cut  down  upon  and 
its  color  and  contents  ascertained.  After  death  the 
arteries  are  pale  or  yellowish  and  empty  of  blood, 
while  during  life  they  pulsate,  and  have  the  color  of 
the  surrounding  tissues. 


SIGNS,  MODES,   CAUSES,  ETC.,  OF  DEATH.        51 

If  during  life  a  little  ammonia  solution  be  subcutane- 
ously  injected,  a  port-wine  congestion  is  set  up  in  the 
surrounding  tissues,  but  no  such  redness  results  when 
the  operation  is  performed  upon  the  dead  body;  at 
least,  not  if  the  body  has  been  dead  for  some  hours. 

2.  Another  sign  of  death  is  the  entire  and  continuous 
cessation  of  respiration,  which  may  be  determined  — 

a.  By  holding  a  cold  looking-glass  over  the  mouth 
and  nose,  when  if  respiration  is  present  the  moisture 
exhaled  will  condense  upon  the  mirror;  the  absence, 
however,  of  such  condensation  is  not  a  conclusive 
proof  of  death. 

6.  By  suspending  a  feather  or  other  light  body  near 
the  mouth  and  nose;  here  again,  the  caution  above 
given  is  applicable. 

c.  By  standing  a  glass  of  water  or  mercury  on  the 
naked  chest,  whereby  the  slightest  motion  will  become 
perceptible. 

With  reference  to  these  last  three  tests,  it  should  be 
remembered  that  it  is  consistent  with  life  that  for  a 
short  time  respiration  may  be  practically  imperceptible ; 
it  is  only  the  entire  and  continuous  cessation  of  respira- 
tion which  is  indicative  of  death. 

3.  Insensibility  and  the  loss  of  voluntary  motion, 
while  they  frequently  occur  without  resulting  in  death, 
should  be  noticed  in  this  connection.     Such  insensi- 
bility and  inability  to  move  may  arise  from  asphyxia, 
syncope,  apoplexy,  trance,  catalepsy,  the  mesmeric  state, 
and   cases  of  long   and   persistent  sleep,  without  the 
person's  being  dead. 

By  way  of  caution  it  may  be  remarked  that  a  physi- 
cian is  not  justified  in  certifying  the  death  of  the 


52  MEDICAL  JURISPRUDENCE. 

person  unless  the  majority  of  the  signs  of  death  are 
well  marked;  he  should  never  be  satisfied  of  the  fact 
of  death  from  one  or  two  appearances  merely. 

4.   There  are  certain  minor  signs  which  may  be  here 
considered  — 

a.  Dry  heat  may  be  applied  to  the  skin ;  if  this  pro- 
duces a  blister  containing  a  serum  rich  in  albumen, 
while  the  true  skin  after  the  cuticle  has  been  removed, 
presents  a  reddened  appearance,  and  more  especially  if 
after  a  short  interval  a  deeply  injected  red  line  forms 
around   the   blister,  this  is   absolute  evidence  of  the 
vitality  of  the  part  to  which  the  heat  is  applied,  and 
consequently  strong  confirmatory  evidence  of  the  life  of 
the  person ;  but  if  the  blister  contains  merely  air  or  a 
little  non-albuminous  serum,  and  the  true  skin  after  the 
removal  of  the  cuticle  appears  dry  and  glazed  and  no 
red  line  appears  around  the  blister,  it  is  certain  that  the 
part  so  treated  is  dead,  and  the  evidence  is  therefore 
strong  that  the  person  himself  is  dead. 

b.  Caustic  may  be  applied  to  the  skin ;  if  the  skin  is 
living  the  eschar  is  of  a  black  or  reddish-brown  color ; 
but  if  dead  either  no  eschar  is  produced  or  the  skin 
turns  yellow  and  transparent. 

c.  Another  change  prior  to  decomposition  is  what  is 
known  as  the  facies  Hippocratica,  which  is  character- 
ized by  sinking  of  the  eyes,  hollowness  of  the  temples, 
sharpness  of  the  nose  and  chin,  dryness  and  harshness 
of  the  forehead,  sallowness  of  the  countenance,  flaccidity 
and  paleness  of  the  lips,  all  which  precede  death  and 
continue   to    be  recognizable   after  dissolution.      An- 
other almost  constant  appearance  in  the  dead  body 
is  a  more  or  less  flexed  state  of  the  fingers  and  thumbs, 


SIGNS,  MODES,  CAUSES,  ETC.,  OF  DEATH.         53 

the  latter  from  this  cause  being  sometimes  bent  across 
the  palms  and  the  fingers  closed  on  them. 

5.  There  are  certain  changes  in  and  about  the  eye 
which  are  indicative  of  death ;  thus  — 

a.  The  iris  becomes  insensible  to  light,  or,  in  other 
words,  the  pupil  does  not  change  its  size  with  increase 
or  diminution  of  light  thrown  upon  it.  This  symptom, 
however,  occurs  in  many  cases  of  disease  and  in  long- 
persistent  sleep,  and  may  also  be  produced  by  the  action 
of  certain  drugs,  such  as  atropine,  eserine,  etc.  After 
death  the  iris  becomes  more  or  less  flaccid,  and  external 
pressure  may  permanently  affect  the  normal  roundness 
of  the  pupil. 

6.  Again,  the  cornea  becomes  insensible ;  but  this  also 
occurs   during  certain  stages  of  epileptic  fits  and  in 
certain  cerebral  injuries. 

The  eye  loses  its  lustre  and  the  cornea  its  trans- 
parency, as  a  rule,  soon  after  death ;  afterwards  its 
tension  becomes  lessened  and  the  cornea  wrinkled  and 
flaccid  from  the  absorption  of  the  aqueous  humor.  But 
here  again,  the  eye  may  lose  its  lustre  during  life,  and 
sometimes  its  lustre  is  preserved  a  long  time  after  death, 
as  after  poisoning  with  the  oxides  of  carbon,  cyanogen 
and  its  compounds,  etc.  The  same  condition  has  also 
been  observed  after  death  from  apoplexy. 

c.  Soon  after  death  the  conjunctiva  shows  gray,  cloudy 
discolorations,  which  rapidly  become  black 

d.  Loss  of  tonicity  and  of  the  elastic  resistance  of  the 
eye  usually  occurs  in  about  twelve  or  fourteen  hours 
after  death ;  but  this,  again,  may  occur  during  life. 

e.  "Where  the  cornea  is  clear  enough  to  allow  ophthal- 
moscopic  examination,  the  change  of  the  fundus  from 


54  MEDICAL  JURISPRUDENCE. 

the  yellowish-red  color  of  the  living  to  a  yellowish- 
white  hue  is  a  strong  indication  of  death.  After  death, 
also,  the  retinal  veins  show  a  beaded  condition,  due  to 
the  liberation  of  gases  disengaged  from  the  blood. 

6.  Changes  in  the  temperature  of  the  body.  The 
healthy  living  body  has  normally  a  temperature  of  about 
98.6°  Fahrenheit,  or  37°  Centigrade,  which  after  death 
gradually  falls  to  the  temperature  of  the  surrounding 
medium.  The  post-mortem  cooling  derives  its  importance 
from  the  fact  that  this  loss  of  heat  is  progressive,  so  that 
the  temperature  is  many  times  not  merely  a  sign  of  death, 
but  an  indication  of  the  length  of  time  the  body  has 
been  dead.  The  temperature  should  be  taken  at  regular 
intervals  with  a  reliable  thermometer,  the  corrections  of 
which  are  known.  Both  the  external  and  internal  tem- 
perature should  be  taken,  —  the  external  temperature  in 
the  axilla,  and  the  internal  in  the  mouth  or  rectum. 

The  time  within  which  a  body  ordinarily  becomes  cold 
is  stated  by  Casper  to  vary  from  eight  to  twelve  hours. 
Dr.  Tidy  thinks  this  period  too  short,  and  fixes  the 
time  at  from  fifteen  to  twenty  hours  after  death.  Other 
writers  make  the  time  even  longer,  —  as  from  eighteen 
to  twenty-four  hours. 

In  certain  cases  of  disease  or  where  the  body  has  been 
freely  exposed  to  the  air,  draughts,  etc.,  the  cooling 
process  may  be  completed  within  a  much  shorter  time, 
even  in  four  or  five  hours;  while  in  certain  other  ex- 
ceptional diseases  or  under  unfavorable  conditions  for 
cooling,  even  forty-eight  or  seventy-two  hours  may 
elapse  before  the  body  is  cold.  In  certain  cases,  such 
as  death  from  yellow  fever,  cholera,  Bright's  disease, 
abscess  of  the  liver  and  other  abdominal  affections, 


SIGNS,  MODES,   CAUSES,  ETC.,  OF  DEATH.         55 


rheumatic  fever,  small-pox,  tetanus,  and  injuries  to  the 
nervous  system  generally,  there  may  be  a  post-mortem 
elevation  of  internal  temperature  amounting  sometimes 
to  as  much  as  nine  degrees  Fahrenheit.  The  following 
table  contains  the  results  of  the  researches  of  Drs. 
Taylor  and  Wilks  on  external  temperature,  the  ther- 
mometer being  placed  upon  the  skin  of  the  abdomen. 


2  to  3  Flours    4  to  6  Hours 
after  Death,     after  Death. 

6  to  8  Hours 
after  Death. 

12  Hours  or 
more  after 
Death. 

Number  of  Observations. 

76 

49 

29 

35 

Maximum  tempera- 

F. 

c. 

P. 

C. 

F. 

C. 

F. 

C. 

ture  of  the  body  . 

94° 

34.4°    86° 

30.0° 

80° 

26.G° 

79° 

26.1° 

Minimum  tempera- 

ture     

88 

155 

«*> 

16.6 

HO 

15.5 

5tt 

13.3 

Average  tempera- 

ture     

77 

25.0 

74 

23.3 

70 

21.1 

69 

20.5 

Of  internal  temperatures,  Taylor  and  Wilks  record 
cases  of  76°  F.  (24.45°  C.)  seventeen  and  eighteen  hours 
after  death,  and  of  85°  F.  (29.45°  C.)  ten  hours  after 
death. 

The  following  table  of  external  temperatures  records 
the  results  of  135  observations  on  the  bodies  of  persons 
who  had  died  from  various  diseases.  The  temperatures 
were  taken  by  placing  the  thermometer  in  the  axilla : 


Temperature 
of  Body  after 
Death. 

2  to  4  Hours. 

4  to  6  Hours. 

6  to  8  Hours. 

8  to  12  Hours 
or  more. 

F. 

C. 

F. 

C. 

F. 

c. 

F. 

c. 

Maximum 

109.4° 

43.0° 

98.2° 

36.8° 

95.3° 

35.2° 

100.4° 

37.8° 

Minimum 

89.6 

32.0 

806 

27.0 

70.5 

21.4 

62.6 

17.0 

Average 

96.9 

36.1 

90.2 

32.3 

81.7 

27.6 

77.9 

25.5 

56  MEDICAL   JURISPRUDENCE. 

Authorities  differ  very  much  among  themselves  as  to 
the  rate  of  post-mortem  cooling.  The  important  fact  to 
bear  in  mind  in  this  connection  is,  that  the  rate  of 
cooling  is  not  uniform ;  notwithstanding  the  post-mortem 
rise  of  temperature,  it  is  on  the  whole  during  the  earlier 
hours  after  death  that  the  most  rapid  cooling  occurs; 
during  the  later  hours  the  loss  per  hour  becomes 
exceedingly  trifling. 

The  time  occupied  by  the  cooling  process  may  be 
shortened  in  death  from  wasting  diseases,  after  great 
losses  of  blood,  where  the  body  is  exposed  to  air  and 
cold  draughts  in  a  more  or  less  uncovered  state,  on  the 
floor  or  on  other  good  conducting  surface.  It  will  cool 
more  rapidly  in  a  large  well-ventilated  room  than  a 
small  close  one.  Bodies  of  children  or  old  persons  cool 
more  rapidly  than  those  of  adults.  Bodies  of  lean  peo- 
ple cool  more  rapidly  than  those  of  fat.  The  time  of 
cooling  in  death  from  drowning  may  be  shortened  by 
the  temperature  of  the  water.  Again,  the  time  of  cool- 
ing may  be  lengthened  in  acute  diseases,  generally  in 
sudden  death  and  in  cases  of  asphyxia,  except  drown- 
ing^ Warm  clothing,  non-exposure  to  draughts,  pre- 
servation in  a  small  warm  room,  being  well  covered  or 
on  a  non-conducting  material,  will  also  prolong  this 
process. 

7.  Changes  in  the  muscles  and  the  general  condition 
of  the  body  after  death. 

a.  Shortly  after  death  the  muscles  become  flaccid,  the 
jaw  drops,  the  eyelids  lose  their  .tonicity,  the  joints 
become  flexible  and  the  limbs  flabby.  During  this 
period,  however,  the  flabby  muscles  are  capable  of  con- 
tracting under  appropriate  stimuli,  such  as  interrupted 


SIGNS,  MODES,   CAUSES,   ETC.,  OF  DEATH.          57 

electric  currents,  blows,  etc.  This  stage  may  occasionally 
last  only  a  few  minutes,  or  even  be  non-existent ;  but  it 
more  commonly  lasts  about  three  hours.  There  are  no 
well-attested  cases,  however,  where  this  stage  has  been 
prolonged  beyond  twenty-four  hours.  It  is  to  be  ob- 
served that  the  contractility  of  a  muscle  by  electrical 
and  other  stimuli  is  no  certain  test  of  life ;  and  that  the 
non-contractility  of  a  muscle  by  such  stimuli  is  no 
certain  test  of  death. 

b.  At  the  end  of  the  first  stage  of  flaccidity  and 
irritability  follows  what  is  termed  the  stage  of  cadaveric 
rigidity,  or  rigor  mortis,  by  which  is  meant  rigidity  of 
the  muscles  accompanied  by  stiffness  of  the  joints  and 
limbs.  As  soon  as  the  elasticity  and  muscular  irrita- 
bility cease,  rigor  mortis  commences'.  During  this  stage 
the  muscles  retain  the  precise  position  they  occupied  at 
the  time  rigidity  supervened.  This  phenomenon  is 
common  both  to  voluntary  and  involuntary  muscles,  and 
is  altogether  independent  of  the  nervous  system,  of  the 
presence  of  the  air,  and  of  temperature,  although  the 
early  supervention  of  rigor  mortis  may  have  some  in- 
fluence in  quickly  lowering  the  surface  temperature. 

The  true  cause  of  rigor  mortis  is  believed  to  be  the 
coagulation  of  the  myosin  or  muscle  fibrine,  the  albu- 
minous principle  of  the  muscular  tissue.  As  putre- 
faction proceeds,  ammonia  is  developed,  the  coagulated 
myosin  is  dissolved,  and  rigor  mortis  disappears.  The 
reaction  of  the  living  muscle  at  rest  is  faintly  alkaline ; 
contracting  muscle  possesses  a  faintly  acid  reaction. 
During  rigor  mortis  the  muscle  exhibits  a  well-marked 
acid  reaction,  but  when  rigor  mortis  has  passed  away 
the  muscles  exhibit  a  well-marked  alkaline  reaction. 


58  MEDICAL  JURISPRUDENCE. 

Higor  mortis  in  the  voluntary  muscles  usually  com- 
mences at  the  third  or  fourth  hour  after  death,  and  is 
usually  complete  at  about  the  fifth  or  sixth  hour;  it 
comes  on  sooner  in  the  involuntary  muscles  than  in  the 
voluntary. 

Eigor  mortis  may  be  late  in  appearing  in  cases  of 
sudden  death  in  muscular  and  well-developed  subjects  ; 
under  such  circumstances,  when  the  muscles  have  not 
been  previously  fatigued  or  the  body  weakened  by 
disease,  rigidity  may  not  set  in  under  twelve  hours,  or 
even  longer.  Again,  if  the  body  is  exposed  to  cold 
rigor  mortis  is  often  delayed;  there  is,  however,  no 
authenticated  case  where  it  has  been  delayed  beyond 
twenty -four  hours. 

On  the  other  hand  it  may  appear  very  soon  after 
death,  especially  in  certain  parts  of  the  body.  The  eye- 
lids may  become  rigid  within  five  minutes  of  death,  or 
sometimes,  it  is  said,  before  the  heart  has  ceased  to  beat ; 
rigidity  often  sets  in  very  rapidly  in  the  facial  muscles. 
There  are  numerous  recorded  cases  where  rigidity  has 
set  in  while  the  body  has  been  warm,  and  a  case  of 
death  from  typhoid  fever  is  recorded  where  rigidity 
commenced  while  the  heart  was  still  beating,  and  within 
three. minutes  after  respiration  had  ceased. 

Living  contraction  may  pass  at  once  into  rigor  mortis 
without  any  appreciable  intermediate  state  of  muscular 
flaccidity,  and  these  cases  are  confined  to  no  one  special 
mode  of  death.  It  has  been  commonly  observed  that 
where  immediate  rigidity  occurs  the  period  just  pre- 
ceding death  has  been  one  of  great  fatigue  and  physical 
exhaustion. 

When  the  last  attitude  of  life  is  maintained  after 


SIGNS,  MODES,  CAUSES,  ETC.,  OF  DEATH.         59 

death  by  rigor  mortis,  considerable  light  may  be  thrown 
upon  the  question  whether  the  case  is  one  of  homicide 
or  suicide.  In  such  cases  the  position  of  the  dead  body, 
its  relation  to  the  surface  on  which  it  rests,  the  position 
of  the  weapon  or  other  thing  grasped  by  the  hands  should 
immediately  be  carefully  noted.  If  a  weapon  be  found 
loosely  held  in  the  hands  of  the  deceased  no  conclusion 
of  value  can  be  deduced  as  to  the  question  of  suicide  or 
homicide ;  but  if  the  weapon  be  found  firmly  grasped 
by  the  deceased,  suicide  rather  than  homicide  is  in- 
dicated. 

As  to  the  order  after  death  in  which  the  various  parts 
of  the  body  are  affected  by  rigor  mortis,  while  there  are 
some  minor  differences  among  the  authorities,  they  in 
the  main  agree.  The  eyelids  appear  to  be  first  attacked ; 
after  that  it  passes  from  above  downwards,  beginning, 
according  to  Casper,  on  the  back  of  the  neck  and  lower 
jaw,  passing  thence  to  the  facial  muscles,  the  front  of 
the  neck,  the  chest  and  the  upper  extremities,  and  last 
of  all  the  lower  extremities.  It  usually  passes  off  in 
the  same  order  and  once  gone  never  returns,  the  body 
becoming  as  flexible  as  it  formerly  was. 

Rigor  mortis  sometimes  passes  off  very  rapidly,  so 
rapidly  that  it  has  been  reported  never  to  have  occurred  '•> 
and  again  it  sometimes  lasts  a  long  time.  The  length  of 
time  during  which  it  lasts  is  variously  stated,  —  at  from 
sixteen  to  twenty-four  hours  (Taylor),  and  twenty-four 
to  thirty-six  hours  in  summer,  and  thirty-six  to  forty- 
eight  in  winter  (Tidy).  The  time  of  its  appearance  and 
the  duration  of  its  continuance  are  modified  by  age, 
temperature,  and  atmospheric  conditions,  condition  of 
the  muscular  system,  and  the  mode  of  death.  It  is  less 


60  MEDICAL  JURISPRUDENCE. 

marked  in  the  bodies  of  middle-aged  persons  (unless  the 
subject  be  very  muscular)  than  in  the  old,  where  it  is 
most  complete.  In  infants  it  usually  sets  in  very 
rapidly.  A  low  temperature  and  dry  air  favor  a  long 
continuance  of  rigidity.  In  all  cases  of  rigor  mortis 
two  points  require  special  consideration,  —  the  muscular 
development  of  the  subject,  and  the  extent  of  exhaustion 
and  fatigue  preceding  death.  Pdgidity  often  lasts  a  long 
time  after  violent  death ;  after  sudden  death  in  a  mus- 
cular subject  it  often  continues  fourteen  days  or  even 
longer.  Where  death  results  from  a  lingering  disease, 
accompanied  by  great  prostration,  or  from  violence  pre- 
ceded by  intense  physical  fatigue,  rigor  mortis  sets  in 
speedily  and  disappears  quickly;  it  may  even  be  so 
slight  as  to  be  overlooked.  Paralyzed  limbs  are  subject 
to  rigor  mortis ;  in  cases  of  poisoning,  rigidity  as  a  rule 
sets  in  late  and  lasts  long;  in  poisoning,  the  primary 
question  as  regards  rigidity  is  not  so  much  the  action 
of  the  poison  as  the  intensity  of  exhaustion  which  has 
succeeded  death.  Eigidity  usually  continues  long  in 
cases  of  habitual  drunkards. 

It  is  said  that  after  death  from  small-pox,  acute  rheu- 
matism, tetanus,  meningitis,  abdominal  diseases,  pyemia, 
and  the  like,  bodies  become  rigid  rapidly  and  remain  so 
a  long  time. 

Rigor  mortis  may  be  distinguished  from  other  forms 
of  rigidity,  such  as  may  occur  during  life,  by  forcibly 
bending  the  joint ;  when  a  joint  stiff  from  post-mortem 
rigidity  is  forcibly  bent  the  rigidity  passes  away  and 
does  not  return,  provided  rigor  mortis  is  completely  es- 
tablished. If  it  has  not  completely  set  in  when  the 
limb  is  bent,  a  certain  but  less  marked  stiffness  may 


SIGNS,   MODES,   CAUSES,  ETC.,  OF  DEATH.         61 

return.  When  forcibly  bent  the  limb  affected  by  rigor 
mortis  does  not  return  of  its  own  accord  to  its  original 
position ;  but  in  the  rigidity  of  hysteria,  catalepsy,  syn- 
cope, or  that  caused  by  the  action  of  certain  poisons,  the 
stiffness  is  not  destroyed  by  forcibly  bending ;  as  soon 
as  the  force  is  removed  the  limb  at  once  returns  to  its 
original  position.  Post-mortem  rigidity  is  also  accom- 
panied by  a  progressive  loss  of  heat  which  is  not  char- 
acteristic of  any  disease. 

c.  The  third  stage  of  the  changes  in  the  general 
condition  of  the  body  after  death  is  that  of  putre- 
factive decomposition,  which  is  a  spontaneous  change 
common  to  all  nitrogenized  organic  bodies  when  ex- 
posed to  air,  whereby  they  become  resolved  into  new 
and  simpler  products.  It  is  accompanied  by  the  evo- 
lution of  gaseous  compounds,  for  the  most  part  of  sul- 
phur and  phosphorus.  This  stage  usually  commences 
when  rigidity  ceases,  although  in  exceptional  cases  ri- 
gidity and  putrefaction  may  coexist.  Generally,  an 
advanced  putrefaction  is  an  infallible  sign  of  death ;  par- 
tial putrefaction  after  some  local  injuries,  such  as  the  gan- 
grene of  a  portion  of  the  body,  is  not  evidence  of  death. 

Before  considering  the  appearances  due  to  putrefactive 
decomposition,  cadaveric  ecchymoses,  variously  called 
hypostases,  cadaveric  lividities,  post-mortem  stains,  su- 
gillations,  vibices,  should  be  considered,  although  chro- 
nologically they  belong  to  the  first  stage  of  muscular 
flaccid ity,  and  are  not  the  result  of  putrefaction.  By 
cadaveric  ecchymoses  are  meant  certain  post-mortem 
stains  closely  resembling  in  their  general  appearance, 
bruises  or  contusions,  and  occurring  both  externally  and 
internally  on  the  lowest  parts  of  the  body. 


62  MEDICAL  JURISPRUDENCE. 

They  are  both  external  and  internal.  External  ecchy- 
moses  usually  appear  within  the  eight  or  ten  hours 
after  death,  while  the  body  is  warm  and  the  blood 
liquid.  When  the  blood  is  coagulated  and  the  body 
cold  their  progress  and  formation  cease.  The  blood 
within  a  dead  body  coagulates  in  much  the  same  man- 
ner as  it  does  when  withdrawn  from  the  living  body. 
When  drawn  from  the  body  during  life  or  within  the 
first  three  or  four  hours  after  death,  it  coagulates  almost 
immediately  upon  its  exposure  to  the  air;  but  when 
remaining  in  the  body  from  six  to  ten  hours  more  may 
elapse  before  coagulation.  The  time  required  for  coagu- 
lation, whether  in  or  out  of  the  body,  depends  upon  the 
quantity  of  fibrin  in  the  blood.  As  this  varies  greatly 
in  different  diseases,  the  formation  of  post-mortem  ec- 
chymoses  varies  according  to  the  cause  of  death,  —  com- 
ing on  quickly  in  acute  inflammations,  and  slowly  in  other 
diseases,  \vhere  the  quantity  of  the  fibrin  in  the  blood  is 
small,  as  in  phthisis.  These  external  ecchymoses,  livid- 
ities,  or  hypostases  may  readily  be  distinguished  from 
appearances  likely  to  be  confounded  with  them,  by 
attention  to  the  following  criteria:  — 

First,  their  seat,  the  superficial  layer  of  the  true 
skin  ;  secondly,  their  extent,  involving  large  portions 
of  the  body,  or  to  be  met  with  in  different  parts  of  it 
at  the  same  time ;  thirdly,  their  circumference,  which, 
though  irregular  and  slashed,  terminates  abruptly,  and 
not  by  gradual  fading  into  the  surrounding  colorless 
skin ;  fourthly,  the  entire  absence  of  extravasated 
blood  at  their  site ;  and  fifthly,  by  the  absence  of  any 
trace  of  contusion  or  ruffling  at  the  part  of  the  cuticle 
or  true  skin. 


SIGNS,  MODES,   CAUSES,  ETC.,  OF  DEATH.         G3 

If  a  contusion  produced  during  life  is  incised,  blood  at 
once  flows  from  the  cut ;  but  no  effused  or  coagulated 
blood  escapes  upon  incision  of  a  post-mortein  ecchyrno- 
sis,  although  perhaps  a  few  bloody  points  may  be  appar- 
ent. Internal  ecchymoses  or  hypostases  also  occur  in 
the  dependent  parts  of  the  several  viscera,  and  this  fact 
will  serve  to  distinguish  them  from  redness  due  to  dis- 
ease ;  they  are  chiefly  found  in  the  posterior  part  of  the 
brain,  the  posterior  part  of  the  spinal  cord,  the  pos- 
terior part  of  the  lungs,  and  the  dependent  parts  of  the 
stomach  and  intestines. 

Very  soon  after  death  the  coloring-matter  of  the  bile 
oozes  from  the  gall-bladder ;  and  the  contiguous  parts 
of  the  stomach  and  intestines  may  become  thereby 
stained  and  of  a  yellowish  or  greenish-yellow  color. 

Coming  now  to  putrefaction  proper,  it  may  be  ob- 
served that  its  progress  varies  considerably  according  to 
the  character  of  the  soil,  temperature,  humidity,  dryness, 
etc.,  and  whether  the  body  is  immersed  in  water, — 
putrefaction  therein  being  slower  than  in  the  atmos- 
phere, —  and  upon  other  circumstances.  A  temperature 
of  sixty  to  ninety  degrees  Fahrenheit  is  the  most  favor- 
able to  the  process  of  putrefaction ;  in  water  the  process 
is  very  rapid  when  the  fluid  has  a  temperature  of  from 
sixty-four  to  sixty-eight  degrees,  but  very  slow  if  the 
temperature  of  the  fluid  is  lower  than  this.  Other 
things  being  equal,  very  young  infants  putrefy  sooner 
than  adults  or  old  people,  and  females  sooner  than  males. 
Mutilations,  contusions,  ecchymoses,  and  death  from 
acute  diseases  hasten  putrefaction.  Copious  hemorrhages 
before  death  retard  it. 

The  gaseous  products  of  decomposition  in  the  early 


64  MEDICAL  JURISPRUDENCE. 

stages  of  putrefaction  consist  principally  of  sulphuretted 
and  carburetted  hydrogen  and  ammonia,  with  variable 
proportions  of  carbonic  oxide,  phosphoretted  hydrogen, 
nitrogen,  and  carbonic  anhydride.  After  the  fifth  or 
sixth  day  the  proportions  of  sulphuretted  hydrogen  and 
ammonia  diminish,  and  carburetted  hydrogen  and  car- 
bonic oxide  largely  predominate. 

The  principal  phenomena  attending  putrefactive  de- 
composition are  color  changes  and  the  development  of 
gases  of  decomposition,  with  their  consequences.  The 
order  in  which  the  external  phenomena  of  putrefaction 
occur  in  bodies  exposed  to  the  air,  or  buried,  are  thus 
stated,  as  average  results  only,  by  Dr.  Tidy,  whose  rules 
are  with  some  modifications  quoted  from  Casper :  — 

From  twenty-four  to  seventy-two  hours  after  death, 
a  light-green  color  appears  about  the  centre  of  the 
abdomen;  the  eye-balls  are  soft  and  yield  to  external 
pressure. 

From  three  to  five  days  after  death  the  green  color  of 
the  abdomen  becomes  intensified  and  general,  spreading, 
if  the  body  is  exposed  to  the  air  or  buried  in  the  ground, 
in  the  following  order:  genitals,  breast,  face,  neck, 
superior  and  inferior  extremities.  If  submerged  in 
water  the  following  is  the  order,  the  time  of  appearance 
being  later  than  in  case  of  air:  face,  neck,  shoulders, 
sternum,  abdomen,  and  legs. 

From  eight  to  ten  days  after  death  the  color  becomes 
more  intense,  the  face  and  neck  presenting  a  shade  of 
reddish-green.  The  ramifications  of  the  subcutaneous 
veins  on  the  neck,  breasts,  and  limbs,  are  very  apparent ; 
the  patches  congregate ;  gas  begins  to  be  developed  in 
and  to  distend  the  abdomen  and  the  hollow  organs,  and 


SIGNS,  MODES,  CAUSES,  ETC.,  OF  DEATH.         65 

to  form  under  the  skin  in  the  submucous  and  intermus- 
cular  tissues.  The  cornea  falls  in  and  becomes  concave. 
The  sphincter  ani  relaxes.  The  nails  remain  firm. 

From  fourteen  to  twenty-one  days  after  death  the  color 
of  the  whole  body  becomes  intensely  green,  with  brown- 
ish-red or  brownish-black  patches ;  the  body  generally  is 
bloated  and  appears  large  from  the  development  of  gas  in 
the  abdomen,  thorax,  scrotum,  and  the  cellular  tissues  of 
the  body  generally.  The  swollen  condition  of  the  eye- 
lids, lips,  nose,  and  cheeks  usually  obliterates  the  fea- 
tures so  as  to  prevent  identification  of  the  body.  The 
epidermis  peels  off  in  patches,  while  in  certain  parts, 
especially  the  feet,  it  will  be  raised  in  blisters  filled 
with  a  red  or  greenish  fluid,  the  skin  underneath  fre- 
quently appearing  blanched.  The  color  of  the  iris  is 
lost.  The  nails  easily  separate.  The  hair  is  loose. 

From  four  to  six  mouths  after  death  the  thorax  and 
abdomen  burst ;  the  sutures  of  the  skull  give  way ;  the 
viscera  become  pulpy,  or  perhaps  melt  away,  leaving 
the  bones  exposed.  The  bones  of  the  extremities  separ- 
ate at  the  joints. 

At  an  advanced  stage  the  soft  parts  gradually  disap- 
pear. Generally,  the  changes  in  a  body  enclosed  in  a 
coffin  are  similar  to  but  slower  than  those  which  appear 
if  the  body  is  exposed  to  air.  After  periods  varying 
from  a  few  months  to  one  and  a  half  or  two  years  the 
soft  tissues  of  a  body  buried  in  a  coffin  usually  become 
dry  and  brown,  and  the  limbs  and  face  covered  with  a 
soft  white  fungus.  After  a  period  of  four  years  the  vis- 
cera become  so  mixed  together  that  it  is  difficult,  if  not 
impossible,  to  distinguish  them.  At  later  periods  the 
soft  parts  as  a  rule,  entirely  disappear.  The  teeth, 

5 


66  MEDICAL  JURISPRUDENCE. 

bones,  and  hair  are  the  most  indestructible  parts  of  the 
body,  and  may  be  found  in  perfect  preservation  after 
many  years'  burial.  Children's  bones,  however,  decay 
more  rapidly  than  adults'. 

Besides  the  distention  of  the  body  by  the  gases  of 
decomposition  already  mentioned,  they  also  cause  blood 
displacements  and  fluid  effusions,  and  sometimes  move- 
ments of  the  body  simulating  vital  acts.  The  pressure 
produced  by  the  gas  usually  empties  the  heart  and 
large  blood-vessels,  and  forces  the  blood  either  into  the 
superficial  capillaries,  or  into  the  mucous  or  serous 
membranes,  or  into  the  vessels  of  the  viscera,  caus- 
ing a  diffused  and  intense  redness  of  the  skin  and 
areolar  tissue.  In  post-mortem  redness  the  red  color  is 
limited  to  the  course  of  the  vessels,  ano\  may  thus  be 
distinguished  from  inflammatory  redness,  which  is  more 
widely  spread.  The  pressure  resulting  from  the  devel- 
opment of  gases  explains  the  occurrence  of  the  so-called 
post-mortem  hemorrhages,  where  liquid  blood  oozes  from 
a  wound  before  putrefaction  has  commenced.  The  fluid 
effused  into  the  serous  cavities,  especially  the  pleu- 
rse  and  pericardium,  is  caused  by  the  pressure  on  the 
overloaded  capillaries  forcing  the  serum,  brownish-red 
in  color  and  homogeneous  in  nature,  through  the  lining 
walls  of  the  vessels. 

The  following  organs  and  parts  putrefy  rapidly,  and 
as  a  rule  in  the  order  mentioned  :  - — 

1.  The  larynx  and  trachea.  2.  The  brain  of  infants  (the 
adult  braiu  putrefies  much  less  rapidly).  3.  The  stomach. 
4.  The  intestines.  5.  The  spleen.  6.  The  omentum  and 
mesentery.  7.  The  liver,  which  in  children  putrefies  sooner 
than  in  the  case  of  adults.  8.  The  brain  of  adults. 


SIGNS,  MODES,  CAUSES,  ETC.,  OF  DEATH.         67 

The  following  organs  putrefy  slowly,  and  generally  in 
the  order  mentioned  :  — 

1.  The  heart.  2.  The  lungs.  3.  The  kidneys.  4.  The 
bladder.  5.  The  gullet.  6.  The  pancreas.  7.  The  dia- 
phragm. 8.  The  larger  blood-vessels.  9.  The  uterus,  which 
resists  putrefaction  longer  than  any  of  the  other  soft  parts  of 
the  body. 

As  putrefaction  advances  in  bodies  exposed  to  the  air, 
vermin  make  their  appearance.  Eecent  investigations 
tend  to  show  that  the  time  which  has  elapsed  since 
death  may  be  approximately  determined  by  a  skilled 
entomologist  from  the  order  of  development  of  the 
insects  in  the  body. 

In  exceptional  cases  the  body  becomes  desiccated  and 
mummified,  as  where  the  body  is  exposed  to  dry  air  and 
protected  from  moisture. 

Under  certain  conditions  the  soft  parts  of  the  body 
may  be  converted  into  what  is  called  adipocere,  which 
is  an  ammoniacal  soap,  requiring  for  its  formation  fatty 
matter  and  nitrogenous  matter  capable  by  decomposi- 
tion of  yielding  ammonia.  It  is  formed  more  readily 
and  abundantly  in  fat  than  in  lean  bodies,  in  children 
and  in  young  people  than  in  adults.  Complete  immer- 
sion of  the  body  in  running  water  favors  its  formation  ; 
as  does  also  burial  in  an  overcrowded  churchyard,  in 
cess-pool  soil,  or  in  deep  graves. 

There  is  also  an  adipocere  having  lime  and  not  am- 
monia for  its  base,  which  is  commonly  harder  and  whiter 
than  ammonia  adipocere. 

Adipocere  is  a  white  or  yellowish-white  or  brown, 
soapy  body,  of  an  offensive  rancid  odor,  which,  when 


68  MEDICAL  JURISPRUDENCE. 

perfectly  dry,  is  white,  hard,  and  brittle.  It  is  lighter 
than  water,  and  melts  at  about  two  hundred  degrees 
Fahrenheit ;  it  is  very  durable.  The  breast,  cheeks  and 
kidneys  are  the  parts  first  to  undergo  this  change,  and 
later  the  muscles.  The  time  required  for  its  production 
is  variously  stated.  Casper  says  that  in  his  experience 
it  is  not  formed  to  any  extent  under  three  or  four 
months'  submersion  in  water,  or  six  months'  burial  in 
moist  earth. 

There  are  recorded  instances  in  which  adipocere  has 
been  produced  by  immersion  in  water,  or  in  water-closet 
soil  for  a  period  of  a  month  or  six  weeks ;  and  there 
are  several  recorded  cases  of  adult  bodies  being  found 
partly  adipoceratous  after  three  or  four  months'  submer- 
sion in  water ;  and  there  are  many  recorded  cases  where 
the  change  has  been  almost  complete  after  two  or  three 
years'  burial  or  submersion.  Partial  saponification  may 
therefore  be  expected  under  favorable  conditions  after 
three  months'  submersion  in  water  or  twelve  months' 
burial  in  earth. 

Modes  and  Causes  of  Death.  Medical  jurists  de- 
scribe three  modes  of  death,  namely :  by  Syncope,  or 
death  beginning  at  the  heart ;  by  Coma,  or  death  begin- 
ning at  the  head ;  and  by  Apnoea,  or  as  generally  but 
improperly  called,  Asphyxia,  or  death  beginning  at  the 
lungs. 

Death  by  Syncope  may  depend  upon  two  distinct 
causes  :  where  there  is  a  deficiency  of  blood  but  no  de- 
ficiency of  heart-power,  which  is  called  Anasmia ;  or 
where  there  is  a  deficiency  of  heart-power  but  no  want 
of  blood,  which  is  called  Asthenia.  The  symptoms  of 
death  by  anosmia  are  a  mortal  paleness  of  the  cheeks 


SIGNS,  MODES,  CAUSES,  ETC.,   OF  DEATH.          69 

and  lips,  cold  sweats,  dimness  of  vision,  dilated  pupils, 
giddiness,  and  a  weak,  irregular,  or  fluttering  pulse. 
There  may  be  nausea  and  vomiting,  restless  movements 
of  the  limbs,  transient  delirium  with  frequent  hallucina- 
tions of  the  sense  of  hearing,  and  flashes  of  light  before 
the  eyes.  The  breathing  becomes  irregular,  with  sighs 
and  often  gasping ;  there  is  often  hiccough.  Insensibil- 
ity eventually  sets  in.  Convulsions  generally  super- 
vene and  may  be  repeated  once  or  twice  before  death. 
The  heart,  if  examined  soon  after  death,  will  be  found 
contracted,  and  quite,  or  nearly  empty. 

In  death  by  asthenia,  the  hands,  feet,  and  surface 
generally  become  cold  ;  circulation  in  the  extremities  is 
usually  first  arrested,  so  that  the  fingers,  lips,  nose,  and 
ears  become  livid.  The  pulse  becomes  feeble  and  fre- 
quent, and  muscular  weakness  extreme.  The  senses  and 
intellect  retain  their  full  activity  to  the  last ;  the  clear- 
ness of  intellect  distinguishes  collapse  from  concussion 
in  which  consciousness  is  temporarily  lost.  In  asthenia 
the  cavities  of  the  heart  after  death  are  not  contracted, 
but  are  more  or  less  full  of  blood,  or  if  empty,  flabby 
and  dilated. 

In  death  by  syncope  proper,  we  have  a  combination 
of  anosmia  and  asthenia.  Sudden  death  from  shock  is 
probably  the  result  of  syncope,  —  from  causes  acting 
through  the  nervous  system.  The  general  post-mortem 
appearances  after  death  from  syncope  are,  that  the  right 
and  left  sides  of  the  heart  commonly  contain  an  equal 
amount  of  blood.  As  a  rule,  the  brain,  lungs,  and  cap- 
illary system  generally  will  be  found  in  a  normal 
condition. 

in  Coma,  or  death  beginning  at  the  head,  there  is 


70  MEDICAL  JURISPRUDENCE. 

stupor  more  or  less  profound ;  external  impressions  are 
but  feebly  recognized ;  loss  of  sensibility  and  conscious- 
ness gradually  becomes  complete.  The  breathing  be- 
comes slow,  irregular,  and  stertorous,  and  voluntary  con- 
trol of  respiration  is  lost ;  respiration  may,  however,  be 
imperfectly  carried  on  for  a  time  after  consciousness  has 
ceased.  Finally,  the  chest  ceases  to  expand,  the  blood 
is  no  longer  aerated,  and  death  ensues.  The  post-mor- 
tem appearances  in  the  thorax  may  differ  but  slightly 
from  those  found  in  death  beginning  at  the  lungs.  The 
arteries  and  left  side  of  the  heart  are  empty ;  the  right 
side  of  the  heart  and  lungs  moderately  full,  but  not  so 
engorged  as  after  death  from  apncea.  Possibly  effusions 
may  be  found  within  the  head. 

In  Apncea  or  Asphyxia,  where  the  death  begins  at  the 
lungs,  there  is  an  intense  struggle  to  breathe  preceding 
unconsciousness,  vertigo,  loss  of  consciousness,  relaxa- 
tion of  the  sphincters,  general  convulsions,  and  death. 
As  a  general  thing  the  right  side  of  the  heart,  veins, 
capillaries,  and  viscera  are  engorged  with  blood,  while 
the  left  side  of  the  heart  and  arteries  are  comparatively 
empty. 

In  many  deaths,  a  combination  of  these  three  methods 
will  be  found,  and  it  is  often  difficult  to  say  which  is 
predominant.  German  medical  jurists  have  accordingly 
adopted  a  fourth  form  of  death,  called  comato-asphyxia, 
where  the  death  begins  both  at  the  brain  and  lungs. 

The  Causes  of  Sudden  Death  are  various.  Without 
professing  to  give  an  exhaustive  enumeration,  there  may 
be  mentioned,  excluding  violence  and  poisoning,  diseases 
of  the  heart,  especially  fatty  and  brown  degeneration, 
angina  pectoris,  aortic  regurgitation,  rupture  of  the  heart, 


SIGNS,   MODES,   CAUSES,  ETC.,  OF  DEATH.         71 

aneurism  and  thrombosis,  effusions  of  blood  in  the  brain 
or  its  membranes,  pulmonary  apoplexy  and  hemato- 
thorax,  the  rupture  of  visceral  abscesses,  ulcers  of  some 
portion 'of  the  alimentary  tube,  extra-uterine  fcetation, 
rupture  of  the  uterus,  apoplexy  of  the  ovary,  peri-  and 
retro-  uterine  hsernaticele,  rupture  of  the  bladder  or  some 
other  important  viscus,  cholera,  and  the  accidental 
obstruction  of  the  pharynx  or  glottis  by  foreign  bodies. 
Mental  emotions  sometimes  cause  sudden  death. 


CHAPTER  V. 

DEATH   BY  ASPHYXIA;    DKOWNING ;    HANGING;    STRANGU- 
LATION; AND   SUFFOCATION. 

Asphyxia  means  the  imperfect  aeration  or  non-aera- 
tion of  the  blood  from  want  of  air.  There  are  certain 
points  of  resemblance  in  death  by  drowning,  strangula- 
tion, suffocation,  and  the  action  of  poisonous  gases, 
which  may  be  conveniently  considered  at  this  point, 
reserving  characteristic  differences  for  separate  treat- 
ment. 

The  general  symptoms  of  death  by  asphyxia  are  livid- 
ity  of  the  whole  face  and  of  the  extremities,  with 
convulsive  movements,  at  first  more  or  less  voluntary. 
Consciousness  is  soon  lost ;  involuntary  and  unconscious 
spasmodic  clonic  movements  of  the  muscles  and  limbs 
follow ;  the  veins  become  turgid ;  the  pulse  more  and 
more  feeble.  There  is  often  frothing  at  the  mouth,  the 
froth  sometimes  being  tinged  with  blood;  blood  not 
unfrequently  escapes  from  the  nostrils,  vagina,  anus, 
and  other  mucous  tracts.  The  urine,  fceces,  and  semen 
may  be  discharged  involuntarily;  abortive  efforts  at 
respiration  continue  for  a  while,  but  finally  cease,  and 
after  an  interval  the  heart  also  ceases  to  beat. 

Dr.  Tidy  makes  four  distinct  periods  in  asphyxia :  — 

(1.)  A  period  of  intense  sensible  although  ineffectual 
efforts  to  breathe. 


DEATH  BY  ASPHYXIA,  DROWNING,  ETC.  73 

(2.)  A  period  of  insensibility,  with  more  or  less  irreg- 
ular convulsive  and  involuntary  spasms. 

(3.)  A  period  when,  though  life  seems  to  be  at  an  end, 
owing  to  the  failure  of  respiration,  it  may  be  again  re- 
suscitated, because  of  the  continuance  of  the  heart's 
action. 

(4)  Its  termination  in  death  after  the  cessation- of 
the  action  of  the  heart. 

The  first  two  periods  may  occupy  from  three  to  five 
minutes;  from  the  beginning  to  the  end,  ten  minutes 
may  be  regarded  as  an  outside  limit. 

The  post-mortem  appearances  of  death  from  asphyxia 
are  lividity  of  the  lips,  extremities,  and  general  surface ; 
hypostases  or  post-mortem  stainings;  the  engorgement 
of  the  veins  over  the  entire  body  with  dark  blood  (the 
arteries  being  for  the  most  part  empty).  The  lungs  are 
usually  congested.  The  right  heart,  vena  cava,  and 
pulmonary  arteries  are  distended  with  dark  fluid  blood, 
while  the  left  heart,  aorta,  and  pulmonary  veins  are 
usually  nearly  empty.  Extravasations  of  blood  will  be 
found  on  the  mucous  and  serous  membranes.  The 
membranes  of  the  brain  will  usually  be  found  gorged 
with  blood,  and  numerous  bloody  spots  appear  when 
the  brain  is  sliced.  Serum  will  be  found  extravasated 
into  the  serous"  cavities,  and  the  mucous  membranes  will 
generally  be  found  very  turgid.  Rigor  mortis  is  said 
to  set  in  slowly;  the  viscera  will  generally  be  found 
enlarged  and  congested  with  dark  venous  blood,  while 
the  blood  itself  will  be  found  usually  fluid  and  dark  in 
color.  In  death,  however,  from  the  effects  of  carbonic 
oxide  the  blood  will  be  found  of  a  bright  red  color. 

In  hanging  and  other  violent  deaths  the  genital  organs 


74  MEDICAL  JURISPRUDENCE. 

are  often  turgid  and  erect,  while  in  drowning  the  penis 
is  often  retracted  and  the  scrotum  shrunk. 

Drowning.  Distilled  or  rain  water  having  a  specific 
gravity  of  1.000  at  60°  Fah.,  and  sea  water  about  1.028, 
while  the  human  body  has  a  specific  gravity  of  from 
1.08  to  1.10,  slightly  greater  than  that  of  any  water,  the 
naked  human  body  placed  in  water  has  a  slight  ten- 
dency to  sink.  Some  bodies,  however,  will  not  sink  in 
sea  water. 

In  death  by  drowning  there  are  two  distinct  sets  of 
phenomena.  First,  those  due  to  suffocation,  and  occa- 
sionally syncope  and  other  causes  ;  and  secondly,  those 
due  to  prolonged  immersion  in  water.  Under  ordinary 
circumstances,  death  from  drowning  results  from  as- 
phyxia. Asphyxia  commences  in  about  two  minutes  ; 
and  five  minutes  after  submersion,  death  ordinarily 
occurs.  Although  apncea  or  asphyxia  is  the  most  com- 
mon cause  of  death,  death  may  result,  or  at  least  its 
occurrence  be  modified,  by  syncope  due  to  shock,  fright, 
drunkenness,  hysteria,  catalepsy,  etc.  Death  may  also 
result  from  exhaustion,  or  concussion,  —  caused  by  col- 
lision of  the  body  with  some  hard  object,  as  the  bed  of 
the  river,  rocks,  etc.,  —  from  apoplexy,  cramps,  or  in 
epileptics,  from  the  sudden  advent  of  an  epileptic 
seizure. 

According  to  Devergie,  death  results  from  true  as- 
phyxia in  25  per  cent  of  cases  of  drowning,  and  in  the 
remaining  75  per  cent,  from  asphyxia  in  a  more  or  less 
modified  form.  In  all  probability,  therefore,  the  gen- 
eral post-mortem  appearances  will  be  those  of  asphyxia 
already  described.  The  post-mortem  appearances,  how- 
ever, will  vary  according  to  the  length  of  time  of  sub- 


DEATH  BY  ASPHYXIA,  DROWNING,   ETC.  75 

inersion,  whether  the  body  was  completely  submerged, 
has  risen  after  submersion,  etc. 

Among  the  external  appearances  in  case  of  death-  by 
drowning,  may  be  mentioned  the  following :  — 

The  position  of  the  body  may  constitute  important 
evidence ;  thus,  if  a  rope  or  piece  of  any  substance  is 
found  tightly  clutched  in  the  hand,  or  if  two  persons 
are  recovered  clasped  in  each  other's  arms,  the  conclu- 
sion that  death  has  resulted  from  drowning  will  be 
greatly  strengthened. 

Cutis  anserina,  or  goose  skin,  is  found  in  many  cases, 
and  although  not  pathognomoiiic  of  drowning,  its  pres- 
ence is  strongly  suggestive  of  submersion  of  the  body, 
either  during  life  or  soon  after  death. 

The  face  in  case  of  drowning  is  usually  pale  and 
placid,  though  sometimes  rosy  red.  If,  however,  two  or 
three  days  in  summer,  or  eight  or  ten  in  winter,  have 
elapsed  before  the  body  is  recovered,  or  if  after  recovery 
it  has  been  exposed  for  some  time  to  the  air,  it  usually 
appears  red  and  bloated.  In  many  cases  a  watery  froth, 
either  white  or  blood-stained,  will  be  noticed  around  the 
nostrils  where  the  body  has  not  been  out  of  the  water 
longer  than  a  day. 

A  corrugated  condition  of  the  palms  of  the  hands  and 
of  the  soles  of  the  feet,  sometimes  called  "washer- 
women's or  cholera  hand"  may  be  noted,  but  is  not 
indicative  of  submersion  during  life. 

The  pupils  are  commonly  dilated. 

Abrasions  or  excoriations  of  the  fingers  are  commonly 
present,  and  gravel,  sand,  mud,  etc.,  are  often  found 
under  the  finger-nails,  and  fragments  of  weeds  clutched 
in  the  hands. 


76  MEDICAL  JURISPRUDENCE. 

The  penis  is  usually  found  contracted  and  retracted, 
and  the  scrotum  shrunken  and  wrinkled. 

Post-mortem  rigidity  is  generally  present  and  sets  in 
so  rapidly  that  not  uufrequently  the  body  remains  stif- 
fened in  the  last  attitude  of  life. 

Internal  Appearances.  The  brain  in  cases  of  drown- 
ing is  sometimes  congested,  but  not  as  a  rule,  very 
hypersemic.  The  blood  is  generally  fluid  and  of  a  dark 
color  from  want  of  aeration.  The  right  side  of  the  heart, 
pulmonary  arteries,  and  venous  system  are  commonly 
congested  with  a  dark  fluid  blood,  although  sometimes 
the  right  cavity  of  the  heart  is  empty,  and  not  uufre- 
quently the  two  sides  of  the  heart  contain  equal  quan- 
tities of  blood. 

The  larynx,  trachea,  and  bronchi  are  commonly  deeply 
congested,  and  the  lungs  also  are  usually  more  or  less 
congested,  and  so  distended  as  to  completely  fill  the 
chest.  The  presence  of  water  in  the  pulmonary  vesicles 
is  strong  evidence  of  submersion  during  life.  Dr. 
Ogston  states,  however,  that  in  48.7  per  cent  of  cases 
by  drowning,  no  water  was  found  in  the  air-cells  of  the 
lungs.  Commonly,  though  not  invariably,  a  froth,  or 
rather  a  lather,  formed  of  air,  water,  and  mucus,  tinged 
occasionally  with  blood,  will  be  found  in  the  air  pas- 
sages and  around  the  lips  and  nostrils  ;  although  this  is 
usually  present,  its  absence  is  not  proof  that  the  death 
did  not  result  from  drowning. 

The  stomach  and  alimentary  canal  are  often  much 
discolored.  The  presence  of  water  in  the  stomach,  swal- 
lowed during  efforts  to  breathe,  is  a  fairly  constant  ap- 
pearance ;  its  quantity  and  quality  should  be  carefully 
noted,  remembering  that  a  little  water  in  a  water 


DEATH  BY  ASPHYXIA,   DROWNING,  ETC.          77 

drinker's  stomach  is  not  significant.  If  the  quantity  in 
the  stomach  is  above  half  a  pint,  it  may  be  regarded  as 
having  an  important  bearing  upon  the  cause  of  death. 
Its  quality  may  also  afford  important  evidence. 

The  liver,  spleen,  and  kidneys  are  usually  gorged  with 
blood  ;  the  bladder  rarely  contains  bloody  urine.  The 
nose,  lips,  ringers,  toes,  genitals,  etc.,  are  sometimes 
found  to  have  been  gnawed  by  voracious  fish. 

The  question  as  to  how  soon  after  death  by  drowning 
a  body  rises  to  the  surface,  depends  upon  a  variety  of 
circumstances,  such  as  the  season  of  the  year,  —  bodies 
rising  more  rapidly  in  warm  weather ;  the  depth  of  the 
water,  —  bodies  rising  more  easily  in  shallow  than  in 
deep  water ;  the  character  of  the  dress  ;  weights  or  me- 
chanical impediments  to  the  rising  of  the  body;  the 
nature  of  the  body,  being  fat  or  lean,  and  the  specific 
gravity  of  the  water,  —  bodies  rising  less  rapidly  in  fresh 
than  in  salt  water.  Dr.  Tidy  states  that,  as  a  rule,  the 
body  floats  after  from  five  to  eight  days,  and  that  the 
popular  notion  of  a  body  floating  in  three  days  is  con- 
trary to  his  experience,  although  it  may  in  shallow 
water  float  as  soon  as  twelve  hours  after  submersion. 

M.  Devergie's  conclusions  as  to  how  long  the  body 
has  been  under  water,  formed  on  a  large  experience  at 
the  Paris  morgue,  are  substantially  as  follows :  — 

During  the  first  four  or  five  days  there  is  little 
change  ;  post-mortem  rigidity  may  in  some  cases  continue 
to  the  fourth  day,  especially  if  the  water  is  cold. 

The  fourth  or  fifth  day  the  skin  of  the  palms,  and 
particularly  that  of  the  ball  of  the  thumb  and  the  little 
finger,  and  the  lateral  surface  of  the  fingers  begin  to 
whiten.  On  the  sixth  or  eighth  days  this  extends  to 


78  MEDICAL  JURISPRUDENCE. 

the  soles  of  the  feet.  The  skin  of  the  face  softens, 
and  is  of  a  more  or  less  faded  white  than  the  rest  of 
the  body. 

On  the  fifteenth  day  the  face  is  slightly  swollen  and 
red ;  a  green  spot  begins  to  form  on  the  skin  of  the  mid- 
sternum  ;  the  hands  and  feet  are  quite  white,  except  the 
dorsura  of  the  latter;  the  skin  of  the  palms  is  wrinkled  ; 
the  subcutaneous  cellular  tissue  of  the  thorax  is  of  a  red 
color,  and  the  upper  part  of  the  cortex  of  the  brain  is 
green. 

In  one  month  the  face  is  reddish-brown,  the  eyelids 
and  lips  green  and  swollen,  and  the  neck  slightly  green  ; 
a  brown  spot  with  green  areola,  about  six  inches  in  di- 
ameter, occupies  the  upper  and  middle  part  of  the  ster- 
num. The  skin  is  very  wrinkled  and  the  hair  and  nails 
still  adherent.  The  scrotum  and  penis  are  much  dis- 
tended by  gas,  so  that  the  latter  is  sometimes  erect. 
The  lungs  are  emphysematous  with  the  gas  of  putre- 
faction. 

At  six  or  seven  weeks  the  neck  and  thorax  are  very 
green,  and  the  cuticle  at  the  wrists  begins  to  be  de- 
tached. 

At  two  months  the  body  is  covered  with  slime,  which 
penetrates  through  the  clothes ;  the  face  is  enormously 
swollen  and  brown,  the  lips  parted  so  as  to  expose  the 
teeth.  The  skin  on  the  middle  of  the  abdomen,  on  the 
arms,  forearms,  thighs,  and  legs  continues  natural.  From 
this  time  the  skin  with  the  nails  attached  begins  to 
come  off  like  a  glove  from  the  hands  and  feet ;  the  hair 
falls  off  or  can  be  easily  detached  by  pulling ;  the  veins 
are  almost  completely  empty  of  blood  and  filled  with 
gas.  If,  at  the  moment  of  death  the  right  cavities  of 


DEATH  BY  ASPHYXIA,  DROWNING,  ETC.  79 

the  heart  were  gorged  with  blood,  the  internal  surface  of 
the  right  ventricle  will  appear  of  a  jet-black  color. 

At  two  and  a  half  months  the  green  color  of  the  skin 
extends  to  the  arms,  forearms,  and  legs ;  the  nails  are 
quite  detached.  Some  adipocere  will  be  formed  on  the 
cheeks,  chin,  breasts,  armpits  and  internal  parts  of 
the  thighs ;  the  abdomen  is  greatly  distended  by  gas. 
The  muscles  are  not  yet  much  altered  in  color. 

At  three  and  a  half  months  the  scalp,  eyelids,  and 
nose  are  destroyed.  The  skin  of  the  breast  is  generally 
of  a  greenish-brown  color ;  the  centre  of  the  abdomen 
presents  an  opaline  appearance,  scattered  over  with 
small  erosions  caused  by  the  water ;  larger  erosions  are 
found  on  other  parts  of  the  body ;  the  hands  and  feet 
are  bare  of  skin.  There  is  a  space  between  the  lungs 
and  the  pleura  costalis  filled  with  reddish  serum. 

At  four  and  a  half  months  the  face  and  scalp  are  so  de- 
stroyed as  to  leave  the  skull  bare,  —  the  remains  of  the 
face,  neck,  and  part  of  the  thighs  being  converted  into 
adipocere.  As  to  the  formation  of  this  substance,  see 
page  67,  ante. 

Small  eminences  indicating  the  commencement  of 
calcareous  incrustations  are  observed  on  the  prominent 
parts.  The  brain  presents  traces  of  adipocere  on  its  an- 
terior parts. 

The  changes  above  described  will  proceed  more 
rapidly  in  very  hot  weather  or  in  putrid  pools  and 
ponds,  but  more  slowly  in  cold  water  or  in  salt  water,  or 
where  the  body  is  closely  invested  by  clothing.  The 
general  order  of  events,  however,  remains  the  same. 

In  determining  the  question  -whether  drowning  -was 
the  cause  of  the  death,  or  whether  the  person  was  already 


80  MEDICAL  JURISPRUDENCE. 

dead  when  thrown  into  the  water,  it  should  be  remem- 
bered that  no  one  post-mortem  appearance  can  be  re- 
garded as  conclusive ;  a  correct  conclusion  can  only  be 
formed  by  the  consideration  of  all  the  facts  revealed  by 
the  autopsy.  What  these  facts  are  has  already  been 
stated.  It  should  be  remembered,  however,  that  the 
most  characteristic  signs  of  death  by  drowning  are  not 
permanent,  and  that  their  continuance  is  shorter  in  sum- 
mer than  in  winter;  while  the  characteristic  signs 
may  remain  fifteen  days  in  winter,  they  may  disappear 
within  three  days  in  summer.  In  a  post-mortem  after 
a  supposed  drowning,  all  abnormal  and  diseased  con- 
ditions, such  as  might  of  themselves  have  caused  death, 
should  be  noted,  it  being  possible  that  the  body  has 
been  thrown  into  the  water  after  death  from  natural 
causes. 

Very  little  water  is  required  to  drown ;  so  long  as 
the  face  is  covered  it  is  sufficient. 

The  determination  of  the  question  -whether  the  drown- 
ing was  accidental,  suicidal,  or  homicidal,  in  the  absence 
of  marks  of  injury,  or  even  in  the  presence  of  marks 
which  may  have  been  self-inflicted  or  caused  by  the 
water  or  by  objects  in  the  water,  is  very  difficult,  if  not 
impossible.  The  presence,  however,  of  certain  marks  of 
violence,  etc.,  such  as  a  cord  around  the  neck,  stabs, 
pistol  wounds,  etc.,  is  suggestive  of  homicide.  The 
question  whether  the  wounds  were  inflicted  before  death 
and  were  the  cause  of  the  death  may  sometimes  be  de- 
termined by  considerations  stated  in  the  chapter  on 
A\rounds.  Whether  they  are  suicidal,  accidental,  or  hom- 
icidal is  frequently  impossible  to  determine ;  and  when 
it  can  be  determined,  must  depend  upon  the  application 


DEATH  BY  ASPHYXIA,  DROWNING,  ETC.          81 

of  the  ordinary  rules  of  evidence  and  not  upon  the  med- 
ical expert. 

Death  by  Hanging.  By  death  by  hanging  is  meant 
death  caused  by  the  partial  or  total  suspension  of  the 
body  by  the  neck  by  means  of  a  ligature  of  some  sort, 
the  constricting  force  being  the  weight  of  the  body 
itself. 

In  hanging,  death  may  result  from  asphyxia,  cerebral 
hypersemia,  a  combination  of  asphyxia  with  apoplexy, 
syncope,  or  injury  to  the  spinal  cord  and  the  pneumo- 
gastric  nerves.  According  to  Casper,  out  of  eighty-five 
cases  nine  cases  were  caused  by  apoplexy,  fourteen  cases 
by  asphyxia,  and  sixty-two  cases  by  mixed  conditions. 
Whether  death  resulted  from  one  or  the  other  of  these 
causes  will  depend  upon  the  tightness  of  the  ligature, 
the  position  at  which  it  crosses  the  neck,  and  whether 
or  not  force  is  employed,  as  well  as  the  degree  of  force. 
Where  the  ligature  is  very  tight,  or  a  loose  ligature 
crosses  the  neck  above  the  os  hyoides,  asphyxia  will  pre- 
dominate over  coma  ;  where  the  ligature  is  loose,  and  the 
larynx  is  protected  by  the  cord  pressing  against  the  os 
hyoides,  then  coma  will  predominate  over  asphyxia. 
A  combination  of  asphyxia  and  coma  is  commonly 
the  cause  of  death  in  cases  of  hanging  by  suicide, 
and  where  no  violence  has  been  exerted,  the  ligature 
both  preventing  the  return  of  blood  from  the  head, — 
thereby  inducing  congestion  of  the  brain,  —  and  pre- 
venting the  entrance  of  air  to  the  lungs,  thereby 
causing  apncea. 

Dr.  Tidy  states  his  conclusions  thus :  "  (1)  Given 
pressure  both  on  the  air-tubes  and  blood-vessels, 
pressure  on  the  air-tubes  being  only  partial,  death  will 

6 


82  MEDICAL  JURISPRUDENCE. 

probably  result  from  a  combination  of  asphyxia  and 
apoplexy,  but  from  asphyxia  primarily.  (2)  Given  a 
pressure  in  such  a  position  that  the  air-way  is  more 
or  less  protected,  death  may  occur  from  apoplexy  and 
will  then  be  slow.  (3)  Given  a  complete  pressure,  so 
that  the  entrance  of  air  into  the  lungs  is  entirely 
prevented,  death  will  result  from  asphyxia,  and  •will 
be  rapid  and  possibly  even  instantaneous." 

In  cases  where  violence  has  been  exerted,  as  in  felo- 
nious and  homicidal  cases  of  hanging,  when  sufficient 
force  is  applied  to  break  the  transverse  and  other  liga- 
ments, or  to  fracture  the  odontoid  process  of  the  axis, 
death  will  be  rapid,  if  not  instantaneous.  Under  such 
circumstances  the  medulla  oblongata  can  scarcely  es- 
cape severe  injury ;  and  as  this  contains  the  centres 
of  respiration  and  circulation,  death  will  ordinarily  be 
instantaneous. 

In  most  cases  of  hanging  unattended  with  violence, 
there  are  three  distinct  stages :  first,  a  short  stage  of 
semi-unconsciousness,  lasting  from  thirty  seconds  to 
three  minutes;  secondly,  a  stage  of  subjective  death 
but  of  objective  life,  varying  from  ten  minutes  onwards  ; 
and  lastly,  a  stage  of  general  death,  lasting  until  the 
occurrence  of  rigor  mortis. 

Without  repeating  those  appearances  common  to 
death  by  apnoea  or  coma,  the  post-mortem  appearances 
after  death  by  hanging  are  as  follows :  — 

The  body  may  be  found  in  rigor  mortis  in  almost 
any  position.  The  position  of  the  head  will  vary  ac- 
cording to  the  position  of  the  knot  or  of  the  liga- 
ture ;  the  usual  position  in  suicide  is  for  the  head  to 
be  forcibly  flexed  forwards  ;  the  face  is  sometimes  pale 


DEATH  BY   ASPHYXIA,  DROWNING,  ETC.          83 

but  more  often  swollen  and  congested;  the  tongue  is 
usually  enlarged  and  livid,  either  protruding  or  com- 
pressed between  the  teeth ;  the  eyes  are  nearly  always 
staring  and  prominent  and  the  pupils  dilated ;  blood- 
stained froth  is  sometimes  found  about  the  nose  and 
lips ;  the  fists  are  often  shut  down  so  tightly  that  the 
finger-nails  penetrate  the  palms  ;  the  neck  usually  ap- 
pears stretched,  and  will  probably  show  the  marks  of 
the  ligature.  If  the  ligature  is  very  soft  and  the  body 
cut  down  instantly  after  death  there  may  be  no  mark 
of  the  ligature  ;  the  mark,  when  it  exists,  is  usually 
oblique,  following  the  line  of  the  lower  jaw ;  it  is  usu- 
ally non-continuous  where  there  is  only  one  turn  of  the 
cord,  but  where  it  has  passed  around  the  neck  more  than 
once  one  mark  may  be  circular  and  the  other  oblique. 
The  appearance  and  character  of  the  mark  of  course 
vary  with  the  nature  of  the  ligature  and  its  method  of 
application,  the  vitality  of  the  tissues,  and  the  period 
that  has  elapsed  after  death.  Its  size  and  depth  do  not 
necessarily  correspond  with  the  size  of  the  ligature,  al- 
though the  narrower  the  ligature,  and  the  longer  the 
suspension,  the  deeper  as  a  rule  will  be  the  mark. 
It  is  usually  a  well-defined  groove  or  furrow,  single  or 
double,  regular  or  irregular,  like  its  cause.  If  the  person 
is  young  and  the  tissues  healthy  and  the  suspension  brief, 
the  mark  may  be  a  slight  depression  without  change  of 
color  or  at  most  a  red  blush ;  more  frequently,  however, 
the  bottom  of  the  furrow  appears  white,  and  its  edges 
are  usually  slightly  raised  and  red.  The  most  common 
appearance,  however,  according  to  Dr.  Tidy,  presented 
by  the  mark  is  that  of  a  dry,  hard,  yellowish-brown, 
parchment-like  furrow ;  which  condition  was  found  by 


84  MEDICAL  JURISPRUDENCE. 

Dr.  Ogston  in  32i  per  cent  of  his  cases.  This  condition, 
however,  is  not  apparent  till  the  body  has  remained  sus- 
pended after  death  for  several  hours,  and  it  does  not 
prove  suspension  during  life. 

The  state  of  the  genital  organs  is  often  one  of  turges- 
cence ;  the  penis  is  often  more  or  less  erect,  and  there 
is  often  an  emission  of  seminal  or  prostatic  fluid ;  the 
urine  and  faeces  are  sometimes  expelled;  there  is  in- 
variably a  flow  of  saliva  from  the  mouth,  which  be- 
ing a  vital  act,  may  be  regarded  as  evidence  that  the 
suspension  took  place  during  life. 

The  internal  post-mortem  appearances  in  cases  of 
hanging  other  than  those  described  under  the  head 
of  asphyxia  and  coma,  are  the  fracture  or  dislocation  of 
the  cartilages  of  the  larynx  and,  rarely,  the  fracture 
of  the  os  hyoides ;  there  may  also  be  a  dislocation  of 
the  cervical  vertebrae,  accompanied  with  rupture  of  the 
ligaments  and  fracture  of  the  odontoid  process;  the 
inner  and  middle  coats  of  the  carotid  artery  may  be 
ruptured ;  there  may  also  be  lesions  of  the  skin  or  of 
the  deeper-lying  soft  parts ;  the  larynx  and  trachea 
are  usually  deeply  congested  ;  the  condition  of  the  lungs 
and  heart  will  vary  accordingly  as  death  resulted  from 
syncope,  asphyxia,  etc. ;  the  stomach  is  often  so  con- 
gested as  to  resemble  the  effects  of  irritant  poisoning ; 
the  cerebral  vessels  are  rarely  much  congested. 

As  to  whether  hanging  -was  the  cause  of  death  or 
not,  it  must  be  remembered  that  the  mark  of  a  cord 
is  not  conclusive  proof  of  death  by  hanging;  nor  is 
its  absence  conclusive  evidence  that  death  did  not  re- 
sult from  hanging.  The  fact  that  the  body  is  found 
in  such  a  position  that  the  feet  can  touch  the  ground  is 


DEATH  BY  ASPHYXIA,  DROWNING,  ETC.           85 

not  evidence  that  the  death  did  not  result  from  hanging. 
Suicide  by  hanging  is  consistent  with  almost  any  posture 
of  the  body ;  persons  so  dying  have  even  hanged  them- 
selves lying  at  full  length  on  a  bed.  On  the  whole, 
the  medical  jurist  can  seldom  give  a  certain  answer  to 
the  question  whether  death  was  caused  by  hanging. 

The  determination  of  the  question  whether  the  hang- 
ing was  accidental,  suicidal,  or  homicidal  must  usually 
depend  upon  the  circumstances  of  the  case,  and  the  gen- 
eral rules  of  evidence,  with  which  the  medical  jurist 
has  no  concern.  It  may  be  remarked,  however,  that  the 
probabilities  are  in  favor  of  suicide ;  it  must  be  remem- 
bered also  that  hanging  may  occur  by  accident. 

Death  by  Strangulation.  —  By  death  by  strangulation 
is  meant  death  resulting  from  pressure  on  the  neck  ap- 
plied otherwise  than  by  the  weight  of  the  body  itself,  — 
as  by  the  fingers  and  thumb,  knee,  ligatures,  etc.  Death 
by  strangulation  is  generally  due  to  apnoea,  and  hence  the 
post-mortem  appearances  of  asphyxia  are  usually  more 
marked  than  in  death  by  hanging.  The  face  and  extremi- 
ties are  usually  livid  and  swollen;  there  are  minute 
ecchymosed  spots  on  the  skin  of  the  face,  neck,  chest, 
and  conjunctivas ;  blood  occasionally  issues  from  the 
mouth,  nostrils,  ears,  and  eyes ;  the  eyes  are  congested 
and  prominent,  usually  wide  open  with  dilated  pupils  ; 
the  tongue  is  frequently  swollen,  protruded,  dark-col- 
ored, and  sometimes  bitten ;  the  hands  are  commonly 
clenched.  The  marks  on  the  neck  will  vary  according 
to  the  nature  of  the  force  employed.  Where  the  cause 
is  manual  pressure,  marks  of  the  thumb  and  one  or  more 
fingers,  together  with  scratches  caused  by  the  nails,  are 
usually  found  on  the  front  of  the  neck.  Where  strangu- 


86  MEDICAL  JURISPRUDENCE. 

lation  is  caused  by  a  ligature,  a  mark  usually  more 
entirely  encircles  the  ueck  than  in  hanging,  and  is 
generally  lower  and  less  oblique.  Where  the  pressure 
is  caused  by  a  hard  body  wrapped  in  a  handkerchief, 
etc.,  there  may  be  bruises  of  considerable  size  at  one 
spot  on  the  neck.  Generally  effused  blood  will  be 
found  in  the  subcutaneous  areolar  tissue  and  muscles 
under  the  mark.  The  inner  and  middle  coats  of  the 
carotid  arteries  may  be  ruptured ;  the  lining  membranes 
of  the  larynx  and  trachea  are  always  more  or  less  con- 
gested ;  extreme  injury  to  the  neck,  though  it  sometimes 
occurs,  is  not  common.  In  homicidal  throttling  ex- 
tensive lesions  of  the  larynx  usually  occur.  The  brain 
is  sometimes  congested  but  usually  normal;  the  lungs 
are  sometimes  congested  and  sometimes  normal ;  some- 
times patches  of  emphysema  due  to  the  rupture  of  the 
superficial  air-cells,  either  singly  or  in  groups,  are  found 
in  the  lungs ;  the  heart  is  sometimes  empty  and  some- 
times full  of  dark  fluid  blood ;  the  genitals  of  both  male 
and  female  are  sometimes  congested ;  involuntary  dis- 
charges of  urine,  faeces  and  seminal  fluid  may  or  may 
not  occur;  the  stomach  is  often  congested,  sometimes 
normal ;  the  blood  is  usually  very  dark  and  very  fluid. 

It  is  very  difficult  to  determine  whether  death  was 
actually  caused  in  any  instance  by  strangulation.  A 
medical  jurist  would  not  be  justified  in  pronouncing 
death  to  be  the  result  of  strangulation  by  anything  short 
of  distinct  external  marks. 

Whether  a  given  case  of  strangulation  was  suicidal 
or  homicidal  is  a  difficult  question,  and  must  be  deter- 
mined by  the  ordinary  rules  of  evidence. 

Death  by  Suffocation.  —  By  suffocation  is  meant  the 


DEATH  BY   ASPHYXIA,   DROWNING,  ETC.  87 

exclusion  of  fresh  air  from  the  lungs  by  means  other 
than  external  pressure  on  the  trachea.  Within  this 
definition  are  included  both  drowning  and  smothering. 
Drowning  has  already  been  considered  ;  and  in  this  con- 
nection death  by  smothering  alone  will  be  considered. 

Suffocation  may  be  variously  caused,  —  by  direct 
pressure  on  the  thorax ;  by  covering  the  head  with  bed- 
clothes, shawls,  etc. ;  in  case  of  infants,  by  overlying  ;  or 
by  anything  which  will  prevent  the  entrance  of  air  into 
the  lungs.  The  air  passages  may  be  closed  internally 
by  foreign  bodies  either  in  the  air  passages  or  in  the 
oesophagus.  Suffocation  has  also  been  caused  from  ob- 
structions caused  by  the  tongue,  epiglottis,  and  velum 
palati,  during  the  administration  of  anaesthetics  while 
the  patient  is  lying  down.  It  has  also  been  caused  by 
blood  from  the  nose  and  from  wounds  of  the  mouth  or 
throat ;  by  scalds  or  other  irritations  of  the  epiglottis ; 
tumors  pressing  on  the  throat ;  the  bursting  of  an  ab- 
scess in  the  pharynx  or  tonsils ;  and  in  various  other 
methods  too  numerous  to  mention. 

In  cases  of  complete  suffocation,  experiments  render 
it  probable  that  death  will  occur  on  an  average  in  from 
two  to  five  minutes. 

The  post-mortem  appearances  in  death  from  suffoca- 
tion are  principally  those  of  asphyxia  already  described, 
although  it  is  said  these  appearances  are  not  so  well- 
marked  as  might  be  expected.  If  external  violence  has 
been  used  there  may  be  flattening  of  the  nose  and  lips  ; 
ecchymosed  scratches  upon  the  throat  may  be  found. 
Patches  of  lividity,  and  of  dotted  or  punctiform  ecchy- 
moses  will  usually  be  found  on  the  skin  and  conjuncti- 
vse  ;  the  lips  and  extremities  are  usually  livid ;  the  face 


88  MEDICAL  JURISPRUDENCE. 

may  be  pale  or  violet,  but  is  often  placid ;  the  eyes  are 
usually  congested  ;  mucus  and  sometimes  blood-stained 
froth  is  found  about  the  mouth  and  nose ;  the  blood  is 
usually  dark-colored  and  very  liquid ;  the  brain  and  the 
vessels  of  the  pia  mater  are  generally  congested;  fre- 
quently the  right  side  of  the  heart  is  more  or  less  full  of 
blood,  but  occasionally  the  heart  has  been  found  empty  ; 
the  trachea  is  usually  of  a  bright-red  color,  and  often 
contains  bloody  froth ;  the  oesophagus  and  trachea  fre- 
quently exhibit  evidence  of  injury ;  the  lungs  are  some- 
times very  congested,  at  other  times  normal 

Tardieu  and  others  lay  a  special  stress  on  the  exist- 
ence of  punctiform  subpleural  ecchyrnoses,  which  are 
usually  found  at  the  root,  base,  and  lower  margin  of  the 
lungs.  That  these  punctiform  ecchymoses  are  not  in- 
fallible signs  of  death  from  smothering,  seems  to  have 
been  proved  by  Dr.  Ogston,  for  they  are  sometimes  ab- 
sent in  cases  of  death  by  suffocation,  and  they  may  be 
present  when  death  is  due  to  some  other  cause. 

The  kidneys  are  generally  congested.  In  a  post-mor- 
tem examination  in  a  case  of  suspected  smothering,  care- 
ful examination  should  be  made  of  the  air  passages  for 
foreign  bodies. 

As  there  is  no  absolutely  certain  anatomical  appear- 
ance characteristic  of  death  by  strangulation,  the  ques- 
tion whether  death  is  so  caused  does  not  admit  of  a 
positive  answer  from  post-mortem  appearances  alone; 
but  must  be  determined  from  these  in  connection  with 
the  other  evidence  of  the  case. 

The  question  whether  the  death  was  accidental,  sui- 
cidal, or  homicidal  is  one  to  be  determined  by  the  legal 
rather  than  the  medical  jurist. 


CHAPTER  VI. 

DEATH  FROM  HEAT  ;  COLD  ;  LIGHTNING  ;  AND   STARVATION. 

The  average  temperature  of  the  body  in  health  is  98.6° 
F.,  or  37°  C.  in  the  mouth  and  axilla ;  or  from  .9°  to 
1.3°  F.  higher  in  the  vagina  or  rectum.  The  tempera- 
ture may  range  1.8°  F.  above  or  below  the  above 
average  consistently  with  health.  In  disease  or  after 
accidents,  the  temperature  may  rise,  or  fall  below  the 
normal.  In  certain  diseases  it  may  range  as  high  even  as 
115°  F.,  and  there  are  recorded  instances  of  the  tempera- 
ture falling  as  low  as  75°  F. ;  but  such  high  or  low  tem- 
peratures are  very  exceptional.  It  may  be  stated  as  a 
general  rule  that  if  the  temperature  of  a  warm-blooded 
animal  be  raised  for  any  length  of  time  by  any  means 
to  the  extent  of  from  11  to  13  degrees  F.,  death  is 
certain ;  and  that  if  the  normal  temperature  is  for  any 
length  of  time  depressed  from  18  to  27  degrees  F.,  death 
is  equally  certain.  The  very  young  and  the  very  old 
have  limited  powers  of  heat  production,  and  cannot 
therefore  well  endure  extreme  cold.  Young  adults  bear 
cold  the  best,  and  young  males  better  than  females  of 
the  same  age.  With  proper  precautions,  however,  ex- 
treme heat  and  extreme  cold  may  be  tolerated  for  some 
time.  Death  from  cold  is  usually  accidental,  although 
there  are  recorded  instances  of  the  application  of  cold 
for  the  purpose  of  homicide,  especially  in  the  case  of 


90  MEDICAL  JURISPRUDENCE. 

new-born  infants.  A  new-born  child,  if  left  unclothed  or 
exposed  to  the  air  in  a  cold  room,  will  soon  die.  Insane 
persons  are  said  to  be  more  susceptible  to  the  effects  of 
cold  than  sane  persons,  although  frequently  insensible 
so  far  as  their  feelings  are  concerned.  In  the  cases  of 
wounded  persons,  exposure  to  cold  will  also  undoubtedly 
increase  their  danger. 

As  to  the  post-mortem  appearances  in  death  from  cold, 
rigor  mortis  generally  sets  in  slowly  and  lasts  for  a  long 
time.  Dr.  Ogston,  from  the  inspection  of  sixteen  bodies 
after  death  from  cold,  comes  to  the  conclusion  that  where 
all  the  hereinafter  described  appearances  are  encoun- 
tered in  the  same  case,  in  the  absence  of  any  other  ob- 
vious cause  of  death,  they  point  with  high  probability 
to  the  death's  having  been  caused  by  cold.  In  adults 
these  peculiar  appearances  are  :  — 

First,  an  arterial  hue  of  the  blood  generally,  except 
when  viewed  in  mass  within  the  heart.  The  presence 
of  this  coloration  was  not  noted  in  two  cases. 

Second,  an  unusual  accumulation  of  blood  on  both 
sides  of  the  heart,  and  in  the  larger  blood-vessels,  arterial 
and  venous,  of  the  chest. 

Third,  pallor  of  the  general  surface  of  the  body,  and 
anaemia  of  the  viscera  most  largely  supplied  with  blood. 
The  only  exceptions  to  this  were  moderate  congestions  of 
the  brain  in  three  cases,  and  of  the  liver  in  seven. 

Fourth,  irregular  and  diffused  dusky-red  patches  on 
limited  portions  of  the  exterior  of  the  body  encountered 
in  non-dependent  parts ;  these  patches  contrast  forcibly 
witli  the  pallor  of  the  skin  and  general  surface.  "  The 
above  appearances,"  says  Ogston, "  were  not,  however,  so 
universally  met  with  in  the  children  as  in  the  adults. 


DEATH  FROM   HEAT,   COLD,  ETC.  91 

The  arterial  hue  of  the  blood  was  absent  in  one ;  the 
anaemia  of  the  larger  viscera  in  all  but  one  instance. 
The  pallor  of  the  surface  was  present,  nevertheless,  in 
all  but  one  of  the  children,  and  the  dusky-red  patches 
on  the  whole  of  them."  He  states  in  conclusion,  how- 
ever, that  "  the  subject  of  death  by  cold,  so  far  as  it  can 
be  ascertained  by  the  inspection  of  the  dead  body,  re- 
quires further  elucidation  than  has  yet  been  bestowed 
upon  it." 

Certain  parts  of  the  body  may  be  found  frozen,  but 
this  is  usually  a  postmortem  phenomenon ;  putrefaction 
does  not  occur  at  a  freezing  temperature. 

Death  by  Heat.  —  Eespecting  the  immediate  cause  of 
death  by  heat,  "  our  ignorance  "  says  Dr.  Ogston,  "  is  still 
great."  During  the  heated  season  death  from  sun-stroke, 
insolation,  or  thermic  fever  is  not  uncommon.  Something 
more  than  mere  heat  is  probably  necessary  to  induce 
thermic  fever;  for  there  is  a  recorded  instance  where 
a  man  in  good  health  has  remained  in  the  hot  room 
of  a  Turkish  bath  continuously  for  four  days  without 
injury  to  his  health,  the  day  temperature  averaging 
140°  F.,  and  the  night  temperature  125.° 

There  are  three  classes  of  cases  included  under  the 
general  term  "  sun-stroke."  The  first,  which  is  said  to  be 
very  rare,  is  acute  meningitis  or  phrenitis.  In  the  sec- 
ond, there  is  heat  exhaustion  with  collapse,  a  rapid, 
feeble  pulse,  cold  moist  skin  and  a  tendency  to  syncope. 
In  the  third  class  there  is  thermic  fever ;  and  of  this 
fever  the  name  "  sun-stroke  "  is  considered  by  Dr.  Wood 
a  misnomer,  —  it  being  caused  by  the  action  of  external 
heat  independently  of  its  source.  The  phenomena  of 
sun-stroke  and  heat  apoplexy  are  said  to  depend  on  the 


92  MEDICAL  JURISPRUDENCE. 

action  of  the  superheated  blood  upon  the  nerve  centres 
and  large  internal  organs.  But  for  the  further  con- 
sideration of  this  subject  the  student  must  be  referred  to 
technical  works  on  the  practice  of  medicine. 

The  post-mortem  appearances  are,  as  a  rule,  negative  ; 
that  is,  there  are  no  constant  lesions,  and  in  some  cases 
nothing  abnormal  is  found. 

As  to  the  so-called  cases  of  spontaneous  combustion, 
while  it  is  possible  that  under  certain  circumstances,  as 
for  instance,  in  hard  drinkers,  the  body  may  be  preter- 
naturally  combustible,  the  alleged  cases  of  spontaneous 
human  combustion  do  not  seem  to  be  entitled  to  much 
consideration. 

Death  by  Lightning  or  Electricity.  —  In  cases  of  death 
by  lightning,  death  may  be  caused  by  shock,  by  the 
severity  of  resulting  burns  and  wounds,  or  by  the  disor- 
ganization of  tissues  and  rupture  of  structures  necessary 
to  life. 

Where  the  death  has  been  instantaneous,  characteris- 
tic appearances  are  not  invariably  met  with  in  the  body. 
Burns  and  blisters  are  common  effects ;  wounds  and  a 
bruised  condition  of  the  parts  are  not  uncommon ;  livid 
streaks  and  ecchymosed  spots  are  frequent ;  frequently 
the  marks  assume  a  peculiar  arborescent  appearance 
depending  upon  the  course  of  the  veins,  or  the  disposi- 
tion of  metallic  bodies  about  the  person,  which  marks 
are  said  to  be  very  indicative  of  death  by  lightning. 
Various  nervous  and  other  symptoms  often  follow 
a  severe  shock  by  lightning  which  does  not  cause 
death. 

The  indications  of  this  form  of  death  are  strengthened 
by  evidence  in  the  vicinity  of  the  dead  body  of  the 


DEATH  FROM  HEAT,  COLD,  ETC.        93 

effect  of  the  electric  current  on  trees,  buildings,  etc.,  or 
upon  domestic  animals  in  the  vicinity. 

Death  by  Starvation.  —  There  are  two  sorts  of  starva- 
tion, chronic  and  acute.  By  the  former  is  meant  the 
withholding  of  food  either  sufficient  in  quantity  or  pro- 
per in  quality  to  support  life.  It  may  also  result  from 
mal-assirnilation  of  food  in  disease,  nausea  in  pregnancy, 
and  from  other  causes. 

By  acute  starvation  is  meant  the  deprivation  of  all 
food  from  a  person  previously  well  fed.  In  chronic 
starvation  hunger  is  not  a  marked  symptom ;  in  acute 
starvation  intense  hunger  appears  to  be  a  symptom  of 
comparatively  short  duration. 

The  general  symptoms  of  starvation  appear  to  be  those 
of  great  nervous  depression ;  the  pulse  is  usually  slow 
and  soft ;  the  features  collapsed ;  the  voice  hollow  and 
the  breath  offensive.  There  is  usually  a  marked  debil- 
ity, with  great  languor,  listlessness,  irritability,  and  des- 
pondency. The  skin  is  usually  harsh  and  dry,  and 
frequently,  especially  in  chronic  cases,  becomes  covered 
with  a  brownish-colored,  filthy-looking  coating.  There 
is  great  emaciation ;  pain  and  irritation  in  the  stomach 
are  usually  troublesome.  As  a  rule,  the  bowels  are 
very  costive  and  the  body  generally  feels  cold.  The 
mucous  membranes  of  the  outlets  of  the  body  are  fre- 
quently red  and  inflamed  ;  the  temperature  is  generally 
lowered ;  there  is  great  loss  of  weight,  —  amounting,  it 
is  said,  in  fatal  cases,  to  an  average  of  forty  per  cent 
of  the  entire  weight. 

As  to  the  time  of  death  in  starvation,  much  depends 
upon  the  previous  condition  of  the  body,  access  to  fresh 
water,  existence  of  warmth,  age,  etc.  Old  people  seem 


94  MEDICAL  JURISPRUDENCE. 

to  bear  want  of  nourishment  best ;  middle-aged  next ; 
those  just  arrived  at  puberty  are  less  able  to  endure  it, 
and  children  are  the  least  able.  The  time  of  the  re- 
corded cases  of  death  from  starvation,  without  taking 
into  account  access  to  water,  varies  from  the  seventh  to 
the  sixtieth  day.  The  average  period  of  death  in  case 
of  complete  deprivation  of  food  would  seem  to  be  from 
seven  to  ten  days.  The  longest  authentic  period  of 
total  deprivation  of  food  in  human  beings,  according  to 
Woodman  and  Tidy,  is  about  six  weeks.  In  the  case 
of  Griscom,  reported  by  Dr.  Lester  Curtis,  of  Chicago, 
the  fast  extended  forty-five  days  without  fatal  results. 
The  cases  of  deprivation  of  food  longer  than  this,  and 
most  of  those  much  shorter,  may  well  be  regarded  with 
suspicion. 

Our  knowledge  of  the  post-mortem  appearances  in 
cases  of  starvation  is  principally  derived  from  chronic 
cases.  In  such  cases  the  body  is  always  greatly  emaciated, 
and  there  is  an  almost  entire  absence  of  fat ;  sometimes, 
however,  one  part  is  much  more  emaciated  than  an- 
other. The  condition  of  the  skin  has  already  been  noted ; 
the  muscles  are  commonly  soft,  pale,  and  wasted ;  the 
heart  is  generally  not  quite  empty ;  it  is  usually,  how- 
ever, more  or  less  contracted,  and  sometimes  soft  and 
bloodless.  The  oesophagus  is  usually  small  and  con- 
tracted. The  condition  of  the  stomach  has  been  variously 
recorded  as  natural,  as  small  and  contracted,  as  corru- 
gated, as  loose  and  flabby.  It  frequently  contains  a  lit- 
tle dark,  gelatinous  fluid.  The  small  intestines  are 
generally  contracted  both  in  length  and  calibre,  and  are 
commonly  thin  and  transparent ;  they  are  sometimes 
empty,  sometimes  contain  a  little  dirty  mucus,  and  are 


DEATH  FROM  HEAT,  COLD,  ETC.       95 

sometimes  distended  with  gas.  The  large  intestines 
are  usually  transparent,  and  frequently  contain  hard, 
faecal  matter ;  the  omentum  is  usually  transparent ;  the 
liver  is  usually  healthy  but  contracted ;  the  gall-bladder 
is  usually  full ;  the  pancreas  is  invariably  atrophied,  and 
the  bladder  invariably  empty  ;  the  tissues  of  the  uterus 
are  often  soft  and  relaxed. 

A  contracted  state  of  the  stomach  and  bladder,  and  a 
shrunken  and  transparent  condition  of  the  intestines 
and  omentum,  with  a  more  or  less  atrophied  but  other- 
wise healthy  condition  of  the  viscera,  appear  to  be  the 
prominent  post-mortem  appearances  after  death  from 
starvation. 


CHAPTER  VII 

PREGNANCY. 

THE  general  opinion  of  the  profession  is  generally 
believed,  at  least  up  to  a  very  recent  period,  to  be  the 
same  as  that  expressed  by  Dr.  Emmett,  who  in  his 
work  on  Gynecology  has  said,  "Pregnancy  may  be 
suspected,  but  we  have  no  sure  and  at  the  same  time 
lawful  means  of  proving  its  existence  before  quickening, 
or  until  the  enlarged  uterus  has  risen  from  the  pelvis 
into  the  abdominal  cavity ;  when  this  has  occurred,  if 
pregnancy  exists  the  beating  of  the  foetal  heart  may 
be  detected,  or  the  motion  of  the  child  may  be  felt, 
and  either  of  these  must  be  accepted  as  conclusive 
evidence." 

While  this  statement  is  probably  correct,  still,  preg- 
nancy can  hardly  exist  without  furnishing  evidence  of 
its  existence ;  and  although  perhaps  its  existence  can- 
not be  demonstrated  conclusively  before  quickening, 
it  may  under  many  circumstances  be  made  highly 
probable. 

In  determining  whether  a  living  woman  is,  or  is  not 
pregnant,  it  should  be  emphasized  at  the  outset  that 
the  medical  jurist  should  not  rely  upon  the  statements 
of  the  woman  herself.  The  signs  which  present  them- 
selves prior  to  the  end  of  the  fifth  month  or  the  begin- 


PREGNANCY.  97 

ning  of  the  sixth  are  not  to  be  regarded  as  entirely 
conclusive;  among  these  may  be  mentioned  — 

1.  The  cessation  of  the  menses. 

2.  Various  sympathetic  disorders,  such  as  morning 
sickness,  vomiting,  loss  of  appetite,  salivation,  headache, 
and    toothache.       Morning    sickness    commonly   com- 
mences from  the  second  to  the  sixth  week  after  con- 
ception, and  generally  ends  about  the  fourth  month. 

3.  Changes  in  the  mammae.     These  changes  usually 
begin  with  pregnancy  and  become  clearly  perceptible 
at  the  end  of  six  weeks  or  two  months.     The  breasts 
grow  larger,  firmer,  and  more  knotty.     At  the  end  of 
six  or  seven  weeks  an  areola  or  decided   darkening 
(this  only  applies  to  a  first  pregnancy,  as  it  is  apt  to 
retain  its  color  and  breadth  after  women  have  borne 
one   or  more   children)   will  be   noticed    around    the 
nipple,  varying  in  diameter  from  one  half  to  two  or 
three  inches.     Upon  this  dark  ground  are  to  be  noted 
from  twelve  to  twenty  follicles  or  tubercles  of  a  lighter 
color.     The  superficial  veins  also  become  prominent  as 
pregnancy  advances,  and  sometimes  circular  streaks  will 
be  seen  by  slightly  stretching  the  skin.     The  nipples 
become  more 'prominent  and  swollen,  and  now  begin  to 
secrete  a  milk-like  fluid  which  may  be  squeezed  there-^ 
from.     The  skin  around  the  nipples  is  in  most  cases 
soft  and  moist. 

4.  Abdominal  symptoms.   During  the  first  two  months 
of  pregnancy  there  is  little  change  in  the  size  of  the 
abdomen ;  if  anything  it  is  a  little  flatter.     About  the 
third  mouth,  however,  the  abdomen  begins  to  increase 
in  size;  the  skin  is  gradually  stretched  and  the  navel 
obliterated ;  and  from  this  time  the  abdomen  steadily 

7 


98  MEDICAL  JURISPRUDENCE. 

increases  in  size  till  nearly  the  end  of  gestation.  At 
the  end  of  the  eighth  month,  when  the  uterus  has 
reached  the  eusiforin  cartilage,  the  navel  becomes  very 
prominent. 

Dark  pigment-cells  are  deposited,  especially  along 
the  mesial  line  of  the  abdomen,  extending  from  the 
pubes  to  the  umbilicus  or  the  sternum.  They  are  most 
marked  in  a  dark-complexioned  woman. 

5.  Changes  in  the  vagina  and  uterus.  The  vagina 
in  pregnancy  is  generally  somewhat  relaxed,  its  mucous 
membrane  congested,  giving  it  a  violet  tinge ;  the  inner 
surface  of  the  vulva  also  presents  the  same  appearance. 
This  condition  generally  continues  until  the  fourth  or 
fifth  month.  In  this  connection  mention  should  be 
made  of  the  state  of  the  urine  during  pregnancy.  The 
deposit  known  as  "kiestine"  was  once  thought  to  be 
diagnostic  of  pregnancy,  but  at  the  present  time  it  is 
regarded  as  a  sign  of  little  value. 

The  state  of  the  os  and  cervix  uteri  deserves  particular 
attention.  Soon  after  impregnation,  on  digital  exami- 
nation per  vag'inam,  the  cervix  will  be  felt  to  be  fuller, 
rounder,  and  more  spongy  or  elastic  than  in  its  unim- 
pregnated  state,  while  its  orifice  will  have  lost  its 
transverse  shape  and  well-defined  edge  and  become 
rounder  and  thicker.  Gradually,  as  the  period  of  preg- 
nancy advances,  it  not  only  becomes  less  prominent,  but 
from  and  after  the  sixth  month  more  and  more  flat- 
tened, till  about  the  time  of  delivery,  when  it  can  no 
longer  be  felt.  For  the  first  three  months  it  is  low 
down  in  the  vagina;  a  little  earlier  than  the  fifth 
month  it  rises  with  the  ascent  of  the  uterus  into  the 
abdomen,  and  from  this  period  it  recedes  farther  from 


PREGNANCY.  99 

the  external  parts,  and  ceases  to  be  distinguishable  as 
a  projecting  body.  The  absence  of  these  changes  in  the 
os  or  cervix  uteri  is  of  more  value  than  their  presence. 

The  changes  in  the  body  of  the  uterus  are  important. 
During  the  first  three  months  the  degree  of  its  develop- 
ment is  ascertained  with  difficulty ;  by  the  end  of  the 
fourth  month  the  fundus  of  the  uterus  may  be  felt, 
especially  in  a  thin  person,  above  the  anterior  wall  of 
the  pelvis.  During  the  fifth  mouth  it  has  usually  risen 
between  the  pubes  and  the  umbilicus.  During  the 
sixth  month  the  fundus  rises  as  high  as  the  umbilicus. 
The  seventh  month  it  is  on  a  level  with  a  point  midway 
between  the  umbilicus  and  lower  end  of  the  sternum ; 
and  at  the  end  of  the  eighth  month  it  has  reached  its 
highest  point,  the  level  of  the  ensiform  cartilage,  from 
which  it  settles  to  a  somewhat  lower  position  before 
delivery. 

A  new  sign  has  recently  been  brought  to  the  notice 
of  the  profession  by  Dr.  Hegar  of  Freiburg,  which  seems 
to  be  of  considerable  promise  and  has  recently  attracted 
much  attention.  This  sign  is  said  to  consist  of  an 
unusual  resilience,  compressibility,  softness,  bogginess, 
yielding  and  thinning  of  the  lower  uterine  segment,  — 
that  is,  the  section  immediately  above  the  insertion  of 
the  sacro-uterine  ligaments.  The  remainder  of  the  body 
of  the  uterus  is  often  firm  and  hard,  and  its  shape  is 
stated  to  be  more  fan-like,  or  like  that  of  a  balloon,  than 
the  usual  pear  shape.  This  enlargement  is  especially 
marked  antero-posteriorly ;  the  change  is  most  apparent 
at  the  middle  portion  of  the  lower  segment  in  the  mesial 
line,  the  sides  of  the  organ  being  much  firmer  and  more 
resistant. 


100  MEDICAL  JURISPRUDENCE. 

During  the  fourth  month  and  thereafter,  a  low  mur- 
muring or  cooing  sound,  like  that  made  by  gently  blow- 
ing over  the  mouth  of  a  wide  bottle,  but  with  no  impulse, 
may  sometimes  be  made  out;  this  is  called  the  "uterine 
or  placental  souffle;"  this,  however,  is  not  a  certain 
sign  of  pregnancy,  as  it  may  be  caused  by  a  tumor 
pressing  upon  the  aorta  or  the  iliac  vessels. 

6.  Evidence  afforded  by  the  condition  of  the  foetus. 
This  subject  may  be  considered  under  three  heads: 
first,  its  passive  movements ;  secondly,  indications  of  its 
vitality  afforded  by  the  stethoscope ;  and  thirdly,  active 
movements  of  the  fetus,  Usually  called  quickening. 

a.  The  passive  movements  of  the  foetus  may  be 
demonstrated  by  what  is  known  as  "  balottement ; " 
that  is  to  say,  an  impulse  given  to  the  foetus  by  the 
finger  applied  to  the  os  uteri  through  the  vagina  while 
the  woman  is  in  a  standing  position,  or  lying  with  the 
trunk  in  a  semi-recumbent  position,  the  foetus  being 
raised  through  the  liquor  amnii  by  the  finger  giving  the 
impulse,  to  return  again  to  its  original  position  at  the 
lowest  part  of  the  uterus.  It  is  seldom  satisfactory 
earlier  than  about  the  end  of  the  fourth,  or  later  than 
about  the  end  of  the  sixth  month  of  utero  gestation. 
This  sign  is  a  sign  of  considerable  value,  but  probably 
not  conclusive.  The  following  signs  are,  however,  con- 
clusive. 

5.  By  the  use  of  the  stethoscope  applied  to  the  uter- 
ine region  of  the  abdomen,  the  pulsations  of  the  foetal 
heart  may  frequently  be  heard,  although  they  can,  ac- 
cording to  Dr.  Tidy,  seldom  be  satisfactorily  made  out 
earlier  than  the  end  of  the  fifth  month.  According  to 
Dr.  Lusk,  they  may  generally  be  made  out  by  ausculta- 


PREGNANCY.  101 

tion  by  the  eighteenth  to  the  twentieth  week;  under 
favorable  circumstances  they  have  been  detected  as  early 
as  the  fifteenth  to  the  sixteenth  week.  They  resemble 
the  ticking  of  a  watch  under  a  pillow,  and  vary  in  fre- 
quency from  120  to  160  beats  per  minute. 

c.  The  active  movements  of  the  foetus  afford  further 
conclusive  proof  of  pregnancy ;  these  active  movements, 
called  quickening,  are,  according  to  Dr.  Tidy,  experienced 
usually  by  the  pregnant  female  between  the  sixteenth 
and  the  twenty-fourth  week,  but  may  occur  as  early  as 
the  twelfth.  According  to  Dr.  Lusk,  modern  investi- 
gations place  the  time  at  which  the  foetus  first  begins 
to  employ  its  muscles  at  about  the  tenth  week.  It  is, 
however,  according  to  him,  somewhat  rare  for  these 
movements  to  excite  the  attention  of  the  mother  before 
the  sixteenth  to  the  eighteenth  week,  though  experi- 
enced matrons  may  recognize  them  at  an  earlier  period. 
As  a  subjective  symptom  quickening  is  of  little  value, 
but  as  an  objective  symptom  where  care  is  taken  not  to 
confound  it  with  the  contractions  of  the  uterus  itself  or 
with  the  abdominal  muscles,  it  is  conclusive.  This 
foetal  impulse  may,  according  to  Dr.  Tidy,  often  be 
felt  externally  about  the  third  or  fourth  month.  Ac- 
cording to  Lusk,  active  foetal  movements,  such  as  may 
be  recognized  by  the  medical  expert,  seldom  assume 
much  distinctness  before  the  sixth  month.  When 
recognized  distinctly  they  are  conclusive. 

The  signs  of  pregnancy  discoverable  by  a  post-mortem 
examination  are,  aside  from  the  subjective  symptoms, 
chiefly  those  which  would  be  observed  in  the  living; 
besides  these,  however,  the  presence  of  the  ovum  or 
the  existence  of  a  distinct  foetus  with  its  placenta  and 


102  MEDICAL  JURISPRUDENCE. 

membranes  would  be  demonstrated  upon  a  post-mortem 
if  the  woman  were  actually  pregnant. 

A  true  corpus  luteum  should  be  present  in  one  or  both 
ovaries.  By  true  corpus  luteum,  or  the  corpus  luteum  of 
pregnancy,  is  meant  the  cicatrice  formed  after  the  dis- 
charge of  the  impregnated  ovum;  by  a  false  corpus  luteum 
or  menstrual  corpus  luteum,  is  meant  that  which  is  formed 
after  the  discharge  of  the  unimpregnated  ovum  at  each 
menstrual  period.  This  subject  has  in  the  past  afforded 
a  fruitful  field  of  controversy.  Without  entering  into 
the  full  consideration  of  the  subject  (for  which  the 
reader  is  referred  to  standard  works  on  obstetrics  and 
physiology)  it  may  be  said  that  the  subject  has  lost 
much  of  the  importance  formerly  attributed  to  it,  for 
the  reason  that  pregnancy  may  exist  without  the  for- 
mation of  any  true  corpus  luteum,  and  that  corpora  lutca 
may  be  found  where  there  has  been  no  pregnancy  what- 
ever, and  that  even  in  aged  women  long  past  the  child- 
bearing  period. 

The  question  sometimes  arises  for  decision  by  the 
medical  jurist,  whether  a  woman  has  or  has  not  been 
pregnant  at  some  period  in  the  past,  and  may  be  par- 
ticularly important  in  certain  cases  of  disputed  identity 
after  death.  The  presence  of  an  intact  hymen  is  of 
course  very  strong  evidence  that  no  mature  or  nearly 
mature  child  has  been  born  in  the  natural  way.  Ca3- 
sarean  section  would  leave  a  long  scar.  If  the  breasts 
and  genital  organs  preserve  their  elasticity  and  virginal 
character,  the  evidence  is  strong  although  not  con- 
clusive against  previous  pregnancy.  The  reader  is 
referred  in  this  connection  to  the  signs  of  pregnancy, 
ante.  As  a  general  rule,  no  absolutely  certain  opinion 


PREGNANCY.  103 

can  be  given  at  the  autopsy  whether  a  woman  has  or 
has  not  borne  children;  but  as  a  question  of  proba- 
bility some  reliance  may  be  placed  on  the  internal 
appearance  of  the  uterine  walls,  more  especially  as 
respects  their  convexity.  In  the  multiparous  uterus, 
the  anterior  and  posterior  surfaces  of  the  body  of  the 
uterus  are  more  rounded  than  in  the  virgin  uterus.  The 
fundus  instead  of  being  flat  is  convex,  so  that  there  is 
considerable  protuberance  above  a  line  drawn  from  one 
Fallopian  tube  to  the  other ;  the  vaginal  portion  of  the 
neck  is  altered,  being  usually  larger  and  more  prominent 
in  the  vagina.  The  os  uteri,  instead  of  presenting  a 
transverse  fissure  or  smooth  round  aperture,  is  more 
open  and  puckered ;  the  depression  is  more  evident,  and 
the  orifice  considerably  larger.  The  uterus  after  ges- 
tation rarely  returns  to  the  size  of  the  nulliparous  organ; 
its  diameters  are  all  increased ;  the  cavity  of  the  body 
of  the  multiparous  uterus  is  also  considerably  enlarged ; 
the  os  internum  is  less  distinct  and  the  canal  of  the 
cervix  shorter;  the  penniform  rugse  are  considerably 
obliterated;  the  cavity  of  the  body  is  less  distinctly  tri- 
angular in  shape, — the  angles  into  which  the  Fallopian 
tubes  enter  being  less  marked.  Again,  if  the  posterior 
commissure  or  fourchette  be  intact  it  is  morally  certain 
that  the  woman  has  not  given  birth  to  a  child  at  full 
term.  The  posterior  commissure  is,  however,  rarely 
affected  by  sexual  intercourse,  even  in  the  case  of  pros- 
titutes ;  although  it  may  be  destroyed  by  extreme  vio- 
lence short  of  the  birth  of  a  child,  its  ruptured  condition 
is  strong  evidence  of  the  woman's  having  bonie  a  child, 
while  its  intact  condition  is  strong  evidence  of  non- 
delivery, or  at  least  of  non-delivery  at  full  term. 


104  MEDICAL  JURISPRUDENCE. 

As  to  the  time  which  must  elapse  after  delivery  before 
a  woman  can  again  become  pregnant,  it  is  to  be  re- 
marked that  the  time  for  the  restoration  of  the  genital 
organs  to  their  normal  condition  is  very  different  in 
different  women;  and  the  time  which  must  intervene 
between  the  delivery  of  one  child  and  the  conception  of 
a  second  has  been  variously  stated  at  from  fourteen 
days  to  one  month. 

The  subject  of  the  duration  of  pregnancy,  superfce- 
tation  and  other  kindred  subjects,  will  be  considered  in 
the  chapter  on  LEGITIMACY  AND  PATERNITY. 

In  concluding  this  chapter,  it  should  be  always  re- 
membered that  a  medical  man  has  no  right  to  examine 
a  woman  in  a  case  of  suspected  pregnancy  without  her 
full  consent,  unless  under  the  order  of  a  court  of  com- 
petent jurisdiction. 


CHAPTER  VIII. 

DELIVERY. 

The  signs  of  recent  delivery  in  the  living  may  become- 
a  matter  of  inquiry  in  cases  of  suspected  concealment  of 
birth  and  child-murder  as  well  as  in  some  other  cases. 
The  degree  of  certainty  in  such  inquiries  depends  much 
upon  the  time  that  has  elapsed  since  the  birth  of  the 
child.  The  evidence  to  be  derived  from  an  inspection 
of  the  child  will  be  considered  in  another  connection. 
If  the  examination  of  the  alleged  mother  be  conducted 
within  a  week,  most  of  the  following  symptoms  will 
be  present;  but  if  the  examination  be  delayed  much 
beyond  a  week  or  ten  days  the  evidence  of  recent 
delivery  will  be  inconclusive  if  not  negative.  The  signs 
of  recent  delivery  at  or  near  full  term,  are  as  follows :  — 

A  peculiar  pallid  expression  of  countenance ;  eyes 
sunken,  with  a  dark  areola  under  and  around  them ;  a 
peculiar  odor  of  the  body  is  also  present ;  the  skin  is 
usually  soft,  moist,  and  relaxed;  the  pulse  will  be  a  little 
quickened  and  more  than  usually  soft  and  compressible. 

The  time  occupied  by  the  following  signs  is  divided 
by  Dr.  Ogston  into  three  periods :  — 

The  first  period  which  is  of  an  average  duration  of 
forty-eight  hours,  embraces  the  time  from  the  moment 
of  delivery  to  the  approach  of  the  milk  fever.1  If  the 

1  According  to  Lusk,  since  the  general  introduction  of  the  ther- 
mometer into  practice,  and  the  better  understanding  of  the  causes  of 


106  MEDICAL  JURISPRUDENCE. 

woman  be  examined  during  this  period  the  vulva  will  be 
found  gaping ;  the  labia  and  nymphre  torn  and  swollen, 
and  the  fourchette,  if  the  delivery  is  the  first  one,  lac- 
erated ;  the  vagina  will  be  found  soft  and  dilated  and 
more  or  less  bathed  in  mucus ;  the  mouth  of  the  uterus 
very  much  dilated  and  soft.  The  uterus  itself  may  be 
felt  to  be  quite  bulky  by  the  hand  placed  above  the 
pubes ;  the  abdomen  itself  will  be  relaxed  and  in  folds ; 
the  brown  line  noticed  as  a  sign  of  pregnancy  may  also 
be  observed,  and  minute  clefts,  at  first  pink,  afterwards 
white  like  ordinary  scars,  termed  "lineae  albicantes," 
may  be  seen  crossing  each  other  in  all  directions. 

At  the  end  of  some  hours  after  delivery  the  lochial 
discharge  commences,  consisting  at  first  of  pure  blood 
without  special  odor,  and  becoming  toward  the  end  of 
the  second  day,  pale  and  watery.  About  the  third  or 
fourth  day  after  delivery  it  is  almost  entirely  suppressed 
under  the  influence  of  the  milk  fever. 

The  second  period,  which  continues  usually  from 
thirty-six  to  forty-eight  hours,  includes  the  duration  of 
the  milk  fever  and  the  swelling  of  the  breasts.  The  so- 
called  milk  fever  usually  commences  on  the  third  day 

febrile  temperature  in  the  puerperal  state,  the  existence  of  a  distinct 
milk  fever  referable  to  functional  disturbances  in  the  breasts  during 
the  period  in  question  has  been  found  to  be  an  exceptional  occurrence. 
Under  normal  conditions  the  temperatures  of  the  third  day  do  not  rise 
above  100.5°  F.  With  this  sub-febrile  increase  there  is,  however,  often 
considerable  general  disturbance,  indicated  by  slight  chilly  sensations, 
headache,  anorexia,  and  a  quickened  pulse,  —  which,  however,  disappear 
in  the  course  of  twenty-four  hours,  —  with  profuse  perspiration  and  an 
abundant  secretion  of  milk.  As  the  term  milk  fever  is,  however,  in 
common  use,  and  there  is  physiologically  at  this  time  a  temperature 
above  that  of  health,  it  will  be  convenient  in  use  to  retain  the  term. 


DELIVERY.  107 

after  delivery,  but  sometimes  it  begins  on  the  first  or 
second  day,  or  even  as  late  as  the  fourth  or  fifth ;  it  is 
best  marked  in  women  who  do  not  nurse  their  children ; 
it  is  preceded  by  headache,  heat  and  dryness  of  the 
skin;  the  pulse  is  at  first  small  and  hard,  and  then 
becomes  fuller,  and  in  a  few  hours  the  breasts  swell ; 
moisture  on  the  surface  and  an  abundance  of  acrid  sweat 
succeeds.  In  from  six  to  twenty-four  hours  the  fever 
abates  and  a  watery  milk  flows  from  the  nipples,  les- 
sening the  swelling  and  the  tenderness  of  the  breasts, 
which,  however,  disappear  slowly. 

The  third  period  of  from  four  to  five  days  is  indicated 
by  the  characteristic  discharge  of  the  lochia,  which, 
about  the  fourth  or  fifth  day,  as  the  milk  fever  subsides, 
reappears  as  a  more  or  less  consistent  yellowish- white 
fluid,  with  a  characteristic  odor  distinguishing  it  from  all 
other  genital  discharges.  It  quickly  becomes  sero- 
purulent,  and  may  thus  continue  from  fifteeen  days  to 
three  months,  or  even  to  the  return  of  the  menses ;  this 
fully  insures  the  discharge  of  the  fluids  contained  in  the 
uterine  walls,  and  the  contraction  of  the  uterus,  which 
in  five  or  six  weeks  has  nearly  resumed  its  former  di- 
minished volume  in  the  unimpregnated  state ;  for  it 
never  becomes  quite  so  small  as  before.  About  this 
time,  if  the  woman  has  not  nursed  her  child,  the  menses 
usually  reappear.  The  marks  of  contusion  and  dis- 
tention  about  the  vulva  usually  entirely  disappear 
within  two  or  three  days  after  delivery,  and  it  is  chiefly 
during  the  first  and  second  of  the  above  periods,  which 
are  only  approximative,  that  the  fact  of  recent  delivery 
can  be  properly  verified.  The  most  characteristic  sign 
during  the  first  period  is  the  sanguineous  discharge  with 


108  MEDICAL  JURISPRUDENCE. 

the  odor  of  the  liquor  amnii.  The  milk  fever  in  the 
second  stage  may  be  very  slight,  and  does  not  always 
occur.  The  lochia  proper  which  characterizes  the  third 
period  is  a  valuable  sign,  more  conclusive  when  it  con- 
tinues for  some  time  ;  but  when  long  continued  it  may 
be  confounded  with  the  leucorrhceal  discharge,  into 
which  it  sometimes  changes. 

It  should  be  remembered  that  the  proof  of  recent 
delivery  at  full  term  in  the  living  female,  can  only 
safely  be  predicted  upon  the  presence  of  all  or  nearly 
all  of  the  signs  above  enumerated ;  and  that  after  the 
eighth  or  tenth  day,  these  signs  in  general  cease  to  be 
distinguishable.  According  to  Dr.  Lusk,  however,  an 
approximate  estimate  of  the  date  of  confinement  may 
be  made  during  the  first  two  weeks  after  delivery. 

The  signs  of  recent  delivery  before  full  term  are  the 
same  in  kind,  though  less  in  degree  than  those  at  full 
term,  and  are  therefore  much  more  liable  to  mislead. 
In  premature  labor  and  in  abortion,  the  signs  of  de- 
livery, at  whatever  time  investigated,  will  be  found 
indistinct  in  proportion  to  the  immaturity  of  the  ovum. 
In  premature  labor  in  the  later  months,  the  signs  of 
delivery  will  be  nearly  as  distinct  as  at  full  term ; 
but  after  abortion  at  an  early  period,  so  little  change 
is  made  in  the  condition  of  the  uterus  and  other  parts, 
and  the  woman  may  exhibit  otherwise  so  few  signs  of 
pregnancy  even  when  examined  a  day  or  two  after  the 
occurrence,  that  it  may  be  found  impossible  to  form 
any  definite  opinion,  unless  the  structure  of  the  ovum 
can  be  made  out  from  the  substance  expelled  from  the 
uterus. 

It  ought  to  be  remembered,  however,  that  the  birth 


DELIVERY.  109 

of  a  child  in  the  case  of  some  women  causes  so  slight 
a  disturbance  as  hardly  to  interrupt  them  in  the  pursuit 
of  their  ordinary  avocations,  and  that  we  are  liable  to 
underrate  the  strength  and  endurance  of  a  recently 
delivered  female. 

The  question  sometimes  arises  whether  it  is  possible 
for  a  woman  to  be  delivered  in  a  state  of  unconscious- 
ness. Although  such  cases  are  very  rare,  there  can  be 
no  question  that  it  is  possible  and  has  sometimes 
occurred.  There  is  one  recorded  instance  of  delivery 
while  in  an  induced  hypnotic  state. 

As  to  the  evidence  of  delivery  in  the  remote  past,  it 
is  to  be  observed  that  it  seldom  admits  of  being  clearly 
proved.  The  absence  of  the  fourchette,  the  periueal 
cicatrice,  the  irregularity  of  the  cervix  uteri  and  the 
milk  in  the  breasts,  are  none  of  them  conclusive ;  milk 
has  been  found  in  the  breasts  of  virgins,  old  women, 
and  even  of  men. 

As  to  the  signs  of  delivery  discoverable  upon  post- 
mortem, besides  those  already  mentioned,  it  may  be 
stated  that  shortly  after  delivery  the  articulations  of 
the  pelvis  are  found  to  be  more  movable  than  usual ; 
the  shape  of  the  uterus  is  more  globular  than  in  the 
virginal  state ;  its  walls  are  thicker,  more  spongy  and 
vascular,  and  its  dimensions  larger.  Eemains  of  the 
decidua  may  be  found  lining  the  interior  of  the  uterus 
except  where  the  placenta  was  attached,  at  which  place 
the  uterine  surface  will  either  be  raw  and  bloody,  with 
openings  into  the  uterine  sinuses,  or  will  be  covered 
with  mammillae  from  albuminous  deposits;  and  the 
Fallopian  tubes  and  openings  will  appear  swollen  and 
vascular.  These  appearances  gradually  fade  and  noth- 


110  MEDICAL  JURISPRUDENCE. 

ing  satisfactory  can  be  learned  after  the  tenth  day, 
and  even  then  the  examination  will  sometimes  be 
fruitless. 

With  respect  to  the  corpus  luteum  nothing  need  be 
added  to  what  has  already  been  said. 


CHAPTEE  IX. 

BIRTH. 

THIS  topic  regards  primarily  the  infant,  and  the 
mother  only  secondarily.  It  is  often  a  matter  forensi- 
cally  of  great  importance  to  determine  whether  a  child 
has  or  has  not  been  born  alive ;  also  at  times,  whether 
a  child  at  birth  is  mature  or  immature.  The  subjects 
of  Infanticide  and  Abortion  will  be  considered  in 
another  chapter. 

The  meaning  of  the  term  "live  birth"  at  the  common 
law  is,  "that  there  must  be  a  manifestation  of  some 
certain  sign  or  signs  of  life  by  the  child  after  it  is  com- 
pletely born ; "  by  which  is  meant  that  the  child  must 
be  completely  external  to  its  mother.  It  is  not,  how- 
ever, necessary  to  this  definition  that  the  cord  should 
have  been  divided  or  the  placenta  separated.  Such 
being  the  definition  of  live  birth  it  follows  that  the 
time  of  a  child's  birth  is  the  moment  of  its  complete 
expulsion  from  the  body  of  its  mother. 

The  evidence  of  life  derived  from  an  examination  of 
a  child  immediately  after  its  birth,  may  consist  — 

1.  Of  muscular  twitchings.  Mere  muscular  move- 
ment independent  of  breathing,  while  very  unlikely 
to  be  mechanical  or  independent  of  vital  power,  can 
hardly  be  regarded  as  sufficient  evidence  of  live  birth  in 
a  criminal  inquiry ;  certainly  not  unless  observed  by  an 


112  MEDICAL  JURISPRUDENCE. 

experienced  person  accustomed  to  careful  observation  of 
vital  phenomena. 

2.  Respiration,   by  which  we   mean    breathing    as 
evidenced  by  chest  movements,  is  a  certain  sign  of 
life.     The  contrary,  however,  is  not  true ;  a  child  may 
be  alive  without  respiration. 

3.  Crying  after  complete  delivery  is  conclusive  proof 
of  live  birth,  but  a  child  may  be  alive  without  crying. 
It  is  also  well  settled  that  a  child  may  in  some  rare 
cases  cry  during  the  time  of  its  expulsion  from  the 
mother  (vagitus  utcrinus  vel  vaginalis),  and  yet  be  com- 
pletely dead  when  legally  born ;  and  also  that  a  child 
may  be  born  alive  and  not  cry  for  some  time  there- 
after. 

4.  Pulsation  in  the  cord,  being  caused  by  the  um- 
bilical or  hypogastric  arteries  and  due  to  the  action  of 
the  child's  heart,  is  a  clear  sign  of  life. 

5.  The  beating  of  the  child's  heart  after  complete 
birth  is  the  crucial  test  of  live  birth,  and  is  sufficient 
to  establish  this  fact  in  the  absence  of  all  the  other 
signs  of  live  birth. 

The  evidence  of  still  birth  may  consist  in  the  absence 
of  the  foregoing  signs  of  live  birth. 

The  fact  of  the  child's  being  dead  when  born  will  of 
course  be  conclusively  established  if  the  body  is  found 
in  a  state  of  putrefaction  at  the  time  of  birth,  —  such 
putrefaction  being  the  result  of  intra-uterine  macera-c 
tion  in  the  liquor  amnii.  The  appearance  of  the  body 
so  born  dead  is  thus  described  by  Casper :  "  It  is  im- 
possible to  mistake  the  appearance  of  a  child  born 
putrid.  The  swollen  cutis;  the  vesicular  elevation  of 
the  cuticle  or  its  complete  peeling  off;  the  grayish- 


BIRTH.  113 

green  coloration  of  the  body ;  the  putrid  navel-string ; 
the  well  known  stench,  etc.,  do  not  constitute  the 
diagnosis,  since  every  child  even  when  born  alive, 
undergoes  these  putrefactive  changes  in  their  turn  at 
the  proper  time  after  its  death.  On  the  contrary,  most 
of  these  characteristics  are  not  exhibited  by  a  child 
born  putrid.  ...  In  the  first  place  a  child  born  putrid 
is  remarkable  for  its  penetrating  stench  which  cannot 
be  concealed  by  a  thin  coffin  or  chest,  etc. ;  and  which 
though  so  repulsive  and  indestructible,  is  not  yet  the 
usual  well  known  odor  of  putrefying  bodies,  but  has 
something  sweetish,  stale  and  indescribable  about  it, 
which  makes  it  all  the  more  unendurable.  ...  A  child 
born  putrid  has  not  a  shade  of  green  upon  its  skin  but  is 
more  or  less  of  a  coppery  red,  here  and  there  of  a  pure 
flesh  color ;  peeling  of  the  cuticle  is  never  absent,  but 
close  to  recent  patches  of  this  character  older  ones  are 
found  upon  the  body,  the  bases  of  which  are  already 
dark  and  hardened.  The  excoriated  patches  are  moist, 
greasy,  and  continually  exude  a  stinking  sero-sanguino- 
lent  fluid,  which  soaks  through  all  the  coverings  of  the 
body.  The  general  form  of  such  bodies  is  as  remarka- 
ble as  their  color.  While  every  highly  putrefied  corpse 
preserves  for  long  the  roundness  of  the  contour  of  the 
body,  though  its  form  is  disfigured  and  distorted  by 
intumescence,  it  must  strike  every  one,  when  a  child 
born  putrid  is  placed  before  him,  how  great  a  tendency 
is  displayed  by  it  to  flatten  out  and,  as  it  were,  to  fall 
to  pieces.  The  thorax  and  abdomen  lose  their  round- 
ness ;  their  contour  forms  an  ellipse,  from  the  soft  parts 
sinking  outwards  towards  both  sides.  The  head  itself 
(the  bones  of  which  are  loose  and  movable,  as  in  every 

8 


114  MEDICAL  JURISPRUDENCE. 

child's  body)  becomes  flattened,  and  the  face  thereby 
repulsively  disfigured,  as  the  nose  is  flattened  and  the 
cheeks  fall  to  opposite  sides." 

The  fetus  may  remain  in  the  uterus  months  in 
this  condition,  and  sometimes  in  twin  pregnancies,  by 
compression,  one  of  the  infants  is  caused  to  become 
flattened  and  atrophied  so  as  exactly  to  resemble  a 
little  gingerbread  figure. 

The  evidence  of  live  or  still  birth  afforded  by  a  post- 
mortem examination  of  the  body  of  a  child,  will  be 
considered  in  the  chapter  on  INFANTICIDE. 

The  subject  of  the  maturity  or  immaturity  of  a  new- 
born child,  will  be  considered  in  the  chapter  on  LEGITI- 
MACY AND  PATERNITY. 


CHAPTEE   X. 

ABORTION. 

WITHOUT  undertaking  a  legal  definition  of  the  term 
abortion,  which  doubtless  will  be  found  to  differ  in  dif- 
ferent States,  and  without  insisting  upon  the  distinction 
which  the  accoucheur  makes  between  abortion  and  pre- 
mature labor,  the  term  may  in  this  connection  be  con- 
sidered as  applied  to  labor  brought  on  at  any  stage  of 
pregnancy,  and  may  be  considered  under  three  heads. 

1.  Natural  abortion,  which  includes  miscarriage,  or 
the  expulsion  of  the  ovum  or  of  a  non- viable  foetus ; 
and  premature  labor,  or  the  expulsion  of  the  child  after 
it  is  viable. 

2.  Artificial  abortion,  or  the  induction  of  premature 
labor  for  the  purpose  of  saving  the  life  of  the  mother 
and,  if  possible,  of  the  child. 

3.  Criminal  abortion. 

The  full  consideration  of  natural  and  artificial  abor- 
tion belongs  to  technical  treatises  upon  obstetrics.  It 
may  be  observed,  however,  that  natural  abortion  may 
be  caused  by  various  accidental  or  pathological  con- 
ditions of  either  the  mother  or  the  child,  or  may  be 
caused .  partly  by  both.  It  is  often  very  difficult  to 
detect  the  cause,  and  it  is  beyond  the  scope  of  this 
work  to  enter  into  the  further  consideration  of  this 
subject. 


116  MEDICAL  JURISPRUDENCE. 

As  to  artificial  abortion,  there  can  be  no  doubt  that, 
after  due  consultation,  with  the  object  of  saving  the  life 
of  the  mother  or  child,  or  both,  operations  for  the  pur- 
pose of  inducing  abortion  or  premature  labor  are  en- 
tirely justifiable;  indeed,  their  legality  is  sometimes 
recognized  by  statute.  The  cases. where  the  induction 
of  abortion  or  premature  labor  are  justifiable  are  certain 
cases  of  pelvic  deformity;  some  cases  of  obstinate 
vomiting  during  pregnancy;  where  pregnancy  is  com- 
plicated with  insanity;  and  various  other  pathological 
conditions. 

The  term  abortion  is  popularly  understood  as  apply- 
ing to  the  expulsion  of  the  contents  of  the  womb  before 
the  sixth  month  of  gestation ;  but  it  is  believed  that 
the  statutes  upon  the  subject  generally  make  no  such 
distinction. 

The  production  of  abortion  is  generally  made  a  statu- 
tory felony,  and  hence  punishable  by  imprisonment  for 
a  greater  or  less  time  in  the  penitentiary.  It  should 
also  be  remembered  that  if  the  death  of  the  mother  is 
caused,  as  is  not  unfrequently  the  case,  owing  to  the 
usual  ignorance  of  the  operators  or  the  dangerous  nature 
of  the  drugs  employed,  the  crime  is  murder,  although 
the  accused  had  the  full  consent  of  the  woman  to  the 
operation,  and  did  not  intend  to  cause  death. 

A  full  discussion  of  the  legal  questions  involved  be- 
longs more  properly  to  professed  treatises  upon  the  crim- 
inal law.  In  this  connection  we  will  consider  only  the 
means  of  producing  abortion,  and  the  evidence  of  abor- 
tion afforded  by  an  examination  of  the  female  during 
life,  or  after  death,  or  of  the  substances  expelled  from 
the  womb,  instruments  or  drugs  used,  etc. 


ABORTION.  117 

The    means  used   to   produce    criminal    abortion    are 

various.  They  usually  consist  in  the  administration  of 
ecbolic  or  abortifacient  drugs ;  that  is,  medicines  which, 
by  exciting  uterine  contractions,  cause  the  expulsion  of 
the  contents  of  the  uterus.  Almost  every  drug  in  the 
pharmacopoeia  has  been,  at  times,  employed  for  this 
purpose.  The  drugs  usually  employed  belong  either  to 
the  class  of  emetics,  purgatives,  diuretics,  or  emmena- 
gogues.  It  should  be  remembered  that  most  of  the 
drugs  which  have  been  administered  for  this  purpose 
are  not  only  uncertain  in  their  action,  but  owing  to  the 
manner  and  amount  administered,  are  usually  extremely 
dangerous. 

Violent  exercise  or  brutal  violence  employed  in  a 
general  manner,  such  as  copious  general  bleedings,  roll- 
ing down  hill  or  downstairs,  long  walks,  etc.,  have  been 
much  resorted  to,  and  often  without  effecting  their  pur- 
pose. Over-tight  lacing  has  also  been  adopted  for  the 
same  purpose.  It  is  needless  to  remark  that  the  more 
violent  of  these  means  are  almost  as  apt  to  cause  death 
as  abortion. 

Abortion  is  frequently  induced  by  mechanical  in- 
juries to  the  uterus  or  its  contents.  This  is  usually 
accomplished  by  rupturing  or  piercing  the  membranes 
by  some  mechanical  means,  such  as  the  uterine  sound, 
catheters,  injections  of  water,  etc.  The  destruction  of  the 
ovum  or  the  rupture  of  the  membranes  of  course  arrests 
gestation ;  but  after  the  membranes  are  pierced  some 
days  may  elapse  before  the  expulsion  of  the  uterine 
contents ;  and  as  in  the  case  of  abortifacients  so  with 
mechanical  means,  the  most  violent  at  times  fail  to  pro- 
duce the  desired  effect. 


118  MEDICAL  JURISPRUDENCE. 

The  evidence  derived  from  the  examination  of  the 
woman  during  life  is  not  unfrequently  negative.  Very 
much  will  depend  upon  the  period  of  gestation  at  which 
the  crime  was  committed ;  if  committed  at  an  advanced 
period  of  gestation,  what  has  been  said  in  a  previous 
chapter  upon  delivery  is  here  applicable.  The  symp- 
toms of  abortion  during  the  earlier  periods  of  gestation 
are  of  an  exceedingly  evanescent  character  and  may  be 
simulated  by  menstruation.  The  signs  of  abortion  in 
the  living  are  commonly  stated  to  be  a  relaxed  condi- 
tion of  the  vulva  and  passages ;  patulousness  of  the  os 
uteri,  presence  of  the  lochial  secretion,  and  the  character- 
istic smell  common  to  puerperal  women ;  distention  of 
the  breasts ;  general  aneemic  condition ;  excitement  of 
the  pulse,  and  dryness  of  the  skin.  The  os  uteri  may  be 
lacerated,  and  there  may  be  marks  of  violence  on  the 
uterus  and  vagina,  depending  of  course,  upon  the  period 
of  gestation  at  which  the  abortion  was  committed. 

If  the  abortion  happened  naturally  at  an  early  period 
of  utero-gestation,  the  signs  usually  found  may  be  very 
slight  or  altogether  wanting.  After  the  third  month, 
the  insertion  of  the  placenta  may  be  detected  by  a  rough 
place  on  the  inner  uterine  wall.  In  making  a  post-mor- 
tem, punctures,  lacerations,  and  incisions  of  the  uterus 
should  be  carefully  looked  for,  and  care  should  be  taken 
that  the  uterus  is  not  wounded  in  making  the  post-mor- 
tem, although  it  is  not  usually  difficult  to  distinguish 
wounds  made  before  from  those  inflicted  after  death. 
The  stomach  and  intestines,  bladder  and  kidneys  should 
be  particularly  examined  for  marks  of  irritant  poisoning. 
It  should  be  remembered  in  this  connection  that  the 
uterus  of  a  woman  who  has  died  during  menstruation,  is 


ABORTION.  119 

thickened  and  presents  a  swollen  condition  of  its  mucous 
lining,  and  is  generally  hypersemic. 

As  to  the  examination  of  substances  expelled  from 
the  uterus,  if  a  foetus  is  found  it  should  be  carefully  ex- 
amined for  wounds,  etc.,  and  an  endeavor  made  to  deter- 
mine whether  it  was  born  alive,  its  age,  etc.,  in  the 
manner  pointed  out  in  the  chapter  on  INFANTICIDE. 

If  any  instruments  or  drugs  are  found  in  the  pOSSCS- 
sion  of  the  accused,  which  are  supposed  to  be  the  means 
used  in  producing  the  abortion,  they  should  be  carefully 
marked  and  preserved  so  as  to  be  capable  of  future  iden- 
tification, and  chemical  or  microscopic  examination,  if 
necessary. 


CHAPTER  XL 

INFANTICIDE. 

THERE  appears  to  be  some  difference  of  opinion  among 
continental  jurists  as  to  the  meaning  of  the  term  "newly 
born ; "  but  according  to  the  English  and  American  law, 
no  importance  is  attached  to  these  distinctions,  as  it  is 
equally  murder  to  destroy  the  life  of  a  child  which  has 
been  completely  born,  according  to  the  sense  given  that 
term  in  the  last  chapter,  as  it  would  be  feloniously  to 
kill  an  adult.  In  order,  however,  to  constitute  the 
crime  of  murder  at  the  common  law,  it  is  necessary  that 
the  whole  body  of  the  child  should  have  been  born  into 
the  world  prior  to  the  extinction  of  its  life.  It  is  not 
necessary  that  the  umbilical  cord  should  have  been 
severed  nor  that  the  child  should  have  breathed,  if  it 
otherwise  had  life  and  independent  circulation.  The 
full  period  of  gestation  need  not  have  passed.  If  a 
person  intending  to  procure  abortion  causes  the  pre- 
mature expulsion  of  the  child,  whereby  it  dies  after 
birth  from  this  premature  exposure,  this  has  been  held 
to  be  murder.  Cutting  off  the  head,  however,  before 
the  birth  of  the  body,  is  not  murder  at  the  common 
law. 

The  questions  which  will  ordinarily  be  propounded  to 
the  medical  jurist  in  connection  with  the  crime  of  infan- 
ticide are  thus  stated  by  Dr.  Ogston  :  — 


INFANTICIDE.  121 

1.  Has  the  prisoner  been  recently  delivered  ? 

2.  Was  the  child  mature  ? 

3.  Was  it  the  child  of  the  prisoner  ? 

4.  Was  it  dead  or  alive  at  its  birth  ? 

5.  If  alive,  what  was  the  cause  of  its  death  ? 

The  first  inquiry  has  been  already  considered  in  the 
chapter  on  DELIVERY.  The  second  inquiry  will  be  con- 
sidered under  the  head  of  LEGITIMACY  AND  PATERNITY. 
The  solution  of  the  third  question  will  usually  depend 
upon  the  application  of  the  ordinary  rules  of  evidence. 
Much  light  will  be  thrown  upon  the  determination  of 
this  question  from  a  comparison  of  the  state  of  the  child 
with  that  of  its  alleged  mother,  keeping  in  mind  the 
facts  already  stated  in  the  chapter  on  DELIVERY.  It  is 
important  in  questions  of  this  kind  to  fix  the  age  of  the 
infant,  or  the  time  it  may  have  survived  birth  ;  and  the 
date  of  the  child's  birth,  is  to  be  settled,  first,  by  ascer- 
taining the  date  of  its  death,  —  that  is,  whether  it  died  in 
the  maternal  passages,  or  if  after  birth,  how  long  after- 
wards ;  and  secondly,  by  determining  the  period  which 
has  elapsed  after  its  death.  The  indications  of  the  death 
of  an  infant  in  utero  have  already  been  to  some  extent 
considered.  Indications  of  its  death  in  the  maternal 
passages,  or  at  or  immediately  after  its  birth,  will  be 
considered  further  on  in  this  chapter. 

The  determination  of  the  time  the  child  has  survived 
its  birth  rests  upon  the  succession  of  changes  in  its 
body  following  birth,  necessitated  by  the  new  physio- 
logical relations  in  which  it  is  placed  after  leaving  the 
uterus ;  and  this  inquiry  need  not  extend  farther  than  a 
few  days  after  its  birth ;  as,  if  the  child  has  survived 
even  a  few  hours  it  can  rarely  be  destroyed  without 


122  MEDICAL  JURISPRUDENCE. 

leaving  clear  testimony  of  its  having  been  born  alive. 
The  changes  above  referred  to  are  invariable  in  their 
occurrence,  and  when  time  has  been  allowed  for  their 
appearance  are,  except  as  otherwise  below  indicated, 
sure  indications  of  the  child's  having  survived  birth. 
These  changes  are  as  follows :  — 

1.  Expulsion  of  the  meconium,  which  is  a  dark-green 
or  olive-colored  matter  of  a  pulpy  consistence,  and  which 
accumulates  in  the  intestines  of  the  foetus  in  the  later 
months  of  intra-uterine  life,  and  is  discharged  occasion- 
ally at  birth  or  at  periods  varying  from  a  few  hours  to  a 
day  or  even  more  after  birth ;  it  is  sometimes  found  in 
the  liquor  amnii,  and  in  breech  presentations  is  some- 
times expelled  before  the  delivery  of  the  head,  so  that 
the  discharge  of  a  portion  of  this  matter  cannot  be  re- 
garded as  conclusive  evidence  that  the  child  was  alive 
at  the  time  of  its  expulsion. 

2.  The  fall  or  dropping-off  of  the  umbilical  cord.     In 
the  infant  after  its  birth,  whether  alive  or  still-born,  if 
the  death  has  not  long  preceded  the  birth,  the  cord  is 
fresh,  firm,  bluish,  rounded,  more  or  less   spiral,   and 
more  or  less  plump.     The  first  change  in  the  living  in- 
fant after  the  division  of  the  cord  is  the  shrivelling  of 
the  part  attached  to  the  infant,  commencing  at  its  cut 
extremity  and  proceeding  to  the  point  of  attachment  to 
the  abdomen.     This  portion  of  the  cord  then  softens, 
while  around  its  point  of  attachment  there  is  a  marked 
reddening  or  injection  of  the  abdominal  integuments. 
The  cord  next  dries  up,  becoming  at  the  same  time 
brownish  from  its  summit  to  its  base  and  more  or  less 
translucent,  and   now  presents  a  flattened  or  ribbon- 
shaped  appearance,  while   through  its  parchment-like 


INFANTICIDE.  123 

Avails  the  contracted  blood-vessels  within  may  be  seen. 
This  desiccation  usually  begins  on  the  first  or  second 
day  after  birth,  and  is  completed  by  the  end  of  the  fifth 
day.  In  the  dead  child,  the  cord,  instead  of  a  brownish, 
generally  assumes  a  grayish  hue.  Its  investing  mem- 
brane forms  a  pulpy  pellicle;  it  loses  its  previously 
spiral  form  and  its  vessels  have  not  sensibly  dimin- 
ished in  size.  It  is  to  be  remarked,  however,  that 
some  of  the  usual  changes  in  the  living  cord  may  be 
produced  accidentally  or  artificially  in  the  dead  child : 
thus,  its  parchment-like  condition  has  been  imitated  by 
drying,  or  submitting  it  to  pressure.  Its  spiral  condi- 
tion is  not  invariably  met  with  in  the  child  which  has 
survived  its  birth.  The  separation  of  the  cord  from  the 
body  usually  takes  place  the  fifth  or  sixth  day,  some- 
times a  little  earlier  or  later.  During  this  process,  the 
base  of  the  cord  slowly  ulcerates,  the  umbilical  artery 
being  first  divided,  and  somewhat  later,  the  vein ;  this 
ulceration,  with  oozing  of  sero-purulent  matter,  and  the 
existence  of  inflammatory  appearances  after  the  detach- 
ment of  the  cord  (that  is,  up  to  the  tenth  or  fourteenth 
day,  at  which  cicatrization  occurs),  being  a  vital  process, 
is  of  course  clear  evidence  of  live  birth.  In  the  natural 
fall  of  the  cord  the  membranes  are  divided  circularly 
and  cleanly  without  any  detached  fibres,  which  is  sel- 
dom the  case  when  the  cord  has  been  forcibly  torn 
away ;  the  separation  of  the  membranes  also  naturally 
precedes  the  division  of  the  vessels.  Where  the  cord 
has  been  violently  torn  off  the  raw  and  bloody  edges  of 
the  part  sufficiently  distinguish  this  from  the  cicatriza- 
tion after  its  natural  separation.  When  decomposition 
has  taken  place,  or  when  the  cord  has  become  dry,  it  is 


124  MEDICAL  JURISPRUDENCE. 

not  always  easy  to  determine  whether  its  division  was 
by  a  sharp  or  by  a  blunt  instrument. 

3.  The  obliteration  of  the  internal  vessels  peculiar  to 
the  foetus,  namely,  the  umbilical  arteries,  umbilical  vein, 
the  ductus  venosus,  ductus  arteriosus,  and  foramen  ovale. 
The  older  writers  on  medical  jurisprudence  state  that 
the  obliteration  of  these  vessels  and  of  the  foramen  ovale 
occurs  in  a  particular  order  and  at  stated  times  after 
birth,  —  the  umbilical  artery  closing  in  from  twenty-four 
hours  to  three  days ;  the  umbilical  vein  a  little  later ; 
the  ductus  arteriosus  in  about  a  week ;  and  lastly,  the 
foramen  ovale.     Modern  investigation,  however,  shows 
that  their  obliteration  occurs,  both  as  to  time  and  order, 
in  a  very  indeterminate  manner,  and  accordingly  little 
reliance  can  be  placed  upon  their  condition  as  an  evi- 
dence of  live  birth. 

4.  Another  sign  of  the  child's  age  is  the  desquama- 
tion  of  the  cuticle.     This  should  not,  however,  be  con- 
founded with   the  peeling  off  of  the  epidermis   from 
putrefaction  after  death.      The   desquamation   of   the 
cuticle,  properly  so-called,  has   not,  says  Dr.  Ogston, 
been   observed  to  take  place  sooner  than  twenty-four 
hours  after  birth.     It  usually  commences  at  the  child's 
abdomen  and  extends  successively  to  the  chest,  arm- 
pits, groins,  back,  the  extremities,  the  feet  and  hands. 
The  shedding  is  usually  in  the  shape  of  scales,  rarely 
powdery  dust,  and  may  be  expected  to  be  complete  in 
healthy  infants  in  from  thirty  to  sixty  days;    but  in 
weakly  or  diseased  children  it  may  continue  for  an  in- 
definite period.      Where  it  occurs  at  all,  Dr.  Ogston 
considers  that  the  child  must  have  lived  at  least  one 
day. 


INFANTICIDE.  125 

The  series  of  changes  above  noted  are  regarded  as  only 
approximate  in  point  of  time. 

The  evidence  of  development  derived  from  the  state 
of  ossification  of  the  bones  will  be  considered  in  the 
chapter  on  PERSONAL  IDENTITY. 

In  considering  the  question  whether  the  child  was 
dead  or  alive  at  its  birth,  it  is  well  to  bear  in  mind  the 
natural  causes  of  death,  and  those  which  may  result 
from  violence  not  criminally  employed  for  the  purpose 
of  causing  the  death  of  the  child.  The  consideration  of 
the  natural  causes  of  death  is  beyond  the  scope  of  this 
work;  it  may  be  stated,  however,  that  among  those 
causes  are  congenital  debility,  various  diseased  condi- 
tions of  the  vital  organs,  protracted  labor,  hemorrhage, 
death  of  the  mother  before  the  delivery  of  the  child, 
fatal  hemorrhages  from  various  parts  of  the  newly-born 
child,  the  most  common  of  which  is  hemorrhage  from 
the  funis  or  navel,  as  where  the  cord  is  not  properly 
secured  by  ligatures,  etc.  It  should  be  remembered, 
however,  that  while  fatal  hemorrhages  may  occur  from 
an  unligatured  cord,  such  fatal  results  are  very  rare. 

The  question  whether  the  child  was  dead  or  alive  at 
its  birth  may  be  considered  under  two  heads :  — 

1.  The  proofs  of  still  birth.  Such  signs  are  those  which 
go  to  prove,  first,  that  it  was  immature  ;  secondly,  that 
it  was  born  with  organs  in  such  a  state  of  congenital 
malformation  —  or,  thirdly,  of  iutra-uterine  disease  — 
as  negatives  the  possibility  of  its  surviving  birth;  or 
fourthly,  that  it  must  have  died  in  the  uterus  or 
maternal  passages  before  time  had  been  afforded  for 
the  commencement  of  respiration  or  any  other  vital 
changes  which  take  place  immediately  after  birth. 


126  MEDICAL  JURISPRUDENCE. 

The  subject  of  immaturity  has  already,  in  part,  been 
considered,  and  will  be  further  considered  in  the  chap- 
ters on  PATERNITY  and  IDENTITY.  The  subject  of  the 
death  of  the  child  in  utero,  and  intra-uterine  maceration 
has  already  been  considered.  The  subjects  of  intra-uter- 
iue  disease  and  congenital  malformation  more  properly 
belong  to  professed  treatises  on  obstetrics,  etc. 

2.  The  question  whether  the  child  has  been  born 
alive  is,  however,  usually  the  principal  point  to  be  de- 
termined; and  the  principal  obstacle  in  the  way  of  a 
satisfactory  determination  of  this  point  is  the  senseless 
and  inhuman  rule  of  the  common  law,  that  the  body  of 
the  child  must  have  been  entirely  born  before  murder 
may  be  committed  against  it.  This,  however,  is  a  ques- 
tion addressed  to  the  legislature,  and  the  medical  jurist 
can  only  be  expected  to  show  that  the  infant  died  by 
violence  or  wilful  neglect  at  the  time  of  or  subsequent  to 
its  leaving  the  uterus ;  and  that  but  for  such  violence 
or  neglect,  there  was  nothing  to  prevent  it  from  continu- 
ing to  live  in  the  external  world.  While  it  would  no 
doubt  be  murder  to  kill  a  newly-born  infant,  born  living, 
but  which  had  not  as  yet  breathed,  with  the  exception  of 
those  cases  in  which  the  injuries  are  of  such  a  charac- 
ter as  would  of  themselves  destroy  life,  and  could  only 
have  been  inflicted  after  the  child  had  been  born,  it 
will  be  very  difficult,  if  not  impossible,  to  prove  the 
commission  of  such  crime.  In  such  a  case,  the  entire 
absence  of  those  changes  in  the  organs  of  respiration 
and  circiilation  which  distinguish  extra-uterine  from 
intra-uterine  life,  will  render  it  impossible  for  the  med- 
ical jurist  to  decide  by  mere  inspection  of  the  body 
whether  or  not  the  child  has  been  born  alive.  In  such 


INFANTICIDE.  127 

a  case  the  proof  of  the  crime  must  depend  upon  other 
evidence.  Practically,  therefore,  the  only  cases  which 
the  medical  jurist  will  be  called  upon  to  investigate 
are  those  in  which  respiration  has  been  established  prior 
to  the  death  of  the  child.  The  evidence  in  such  cases 
may  be  considered  under  three  aspects  :  — 

a.  The   evidence  afforded  by  changes  in  the  organs 
of  circulation. 

b.  In  the  digestive  organs. 

c.  In  the  respiratory  organs. 

(a)  The  signs  of  extra-uterine  life  derived  from  the 
organs  of  circulation  are  the  obliteration  of  the  umbili- 
cal vessels,  the  ductus  arteriosus,  the  ductus  venosus, 
and  the  foramen  ovate,  due  to  the  new  course  taken  by 
the  blood  on  the  establishment  of  respiration ;  but 
enough  has  been  said  upon  this  subject  in  a  previous 
part  of  this  chapter. 

(6)  The  evidences  of  extra-uterine  life  derived  from 
the  examination  of  the  alimentary  canal  are  as  follows : 
Food  or  medicine  found  in  the  child's  stomach  are  of 
course  conclusive  upon  the  question  of  live  birth.  The 
food  most  likely  to  be  found  will  be  milk,  farinaceous 
articles,  or  sugar.  In  some  cases  opium  in  some  form 
has  been  found  in  the  stomach. 

In  instances  of  drowning  and  smothering,  the  fluid  or 
other  substances  in  which  the  child  has  been  immersed 
may  be  found  in  the  stomach.  According  to  Tardieu  the 
presence  of  air  bubbles  in  the  glairy  mucus  generally 
found  in  the  stomach,  which  he  believes  can  only  have 
arisen  from  the  swallowing  of  saliva  and  mucus  col- 
lected in  the  mouth  and  throat,  and  which  is  aerated  by 
respiration,  —  the  process,  in  his  opinion,  requiring  the 


128  MEDICAL  JURISPRUDENCE. 

period  of  only  a  few  minutes  (from  ten  to  fifteen  at 
most),  —  is  evidence  of  live  birth. 

As  to  the  evidence  afforded  by  the  presence  or  ab- 
sence of  mecouium,  see  ante. 

(e)  The  proof  of  live  birth  principally  relied  upon, 
however,  is  that  afforded  by  the  series  of  changes  in  the 
respiratory  organs.  The  time  required  for  effecting  the 
changes  below-described  varies  with  the  condition  of 
the  infant,  from  a  few  minutes  in  the  mature,  healthy, 
and  vigorous  infant,  to  two  hours  or  even  more  in  the 
case  of  premature,  weakly,  or  diseased  infants,  although 
cases  where  so  long  a  time  is  required  are  exceptional. 

Previous  to  the  admission  of  air  to  the  lungs,  the 
lungs,  on  opening  the  chest,  do  not  appear  to  fill  the 
thoracic  cavity,  but  occupy  a  comparatively  small  por- 
tion of  the  chest;  the  pericardium  occupies  a  promi- 
nent place  in  front,  and  the  heart  is  quite  uncovered  by 
the  lungs,  which  are  placed  laterally  and  posteriorly. 
When,  however,  the  lungs  have  been  expanded  by  the 
admission  of  air,  the  pericardium  is  nearly  covered  by 
them,  and  the  convexity  of  the  diaphragm  is  lessened. 
The  volume  of  the  lungs,  however,  is  not  of  itself  a  con- 
clusive test  of  respiration. 

The  tissue,  consistence,  feeling,  and  color  of  the 
lungs  are  important  to  be  considered  in  this  connection. 
Lungs  not  penetrated  by  air  have  sharp,  well-defined, 
incurved  margins,  are  dense  and  fleshy,  and  do  not  crep- 
itate when  handled  or  cut,  and  no  air  can  be  expressed 
from  their  cut  surfaces  under  water,  and  little  or  no 
blood  is  contained  in  their  tissues.  Their  color  varies 
from  a  chocolate  hue  to  that  of  the  healthy  adult  liver. 
On  the  other  hand,  lungs  which  have  been  inflated  with 


INFANTICIDE.  129 

air,  whether  naturally  or  artificially,  feel  spongy  and 
light,  and  crepitate  on  being  cut  or  handled.  Although 
their  margins  appear  sharp,  a  close  examination  will 
show  that  they  are  really  rounded  or  projecting  in 
tongue-like  processes ;  they  appear  vesicular,  and  when 
the  inspiration  has  been  natural,  blood  may  be  squeezed 
out  of  them.  By  the  entrance  of  air  into  the  fcetal  lung 
upon  the  establishment  of  respiration,  its  previous  liver 
or  chocolate  color  is  changed  to  a  more  or  less  lively 
rose-red.  This  change  of  color,  however,  is  said  by 
Dr.  Taylor  not  to  be  an  invariable  consequence  of  the 
child's  having  lived  after  birth.  Lungs  that  have  in- 
spired air,  whether  naturally  or  not,  very  generally  ex- 
hibit near  their  margins  bright  red  stripes  or  patches ; 
but  in  the  lungs  of  children  which  have  breathed  natu- 
rally there  are,  according  to  Dr.  Ogston,  further  visible 
on  their  surfaces,  defined  patches  of  bright  red,  relieved 
by  the  dark-purplish  intervening  insular  spots,  which 
form  the  ground  tone  of  the  whole.  This  last  mottled 
or  marbled  aspect  is  considered  by  Casper  and  other 
continental  authorities  as  a  sure  test  of  natural  respira- 
tion ;  although,  according  to  Casper,  its  absence  does 
not  lead  to  the  opposite  conclusion. 

The  so-called  static  test,  by  comparing  the  absolute 
weight  of  the  lungs  with  that  of  the  body  of  the  infant 
(although  fcetal  lungs  on  the  establishment  of  respiration 
necessarily  become  heavier),  does  not  seem  to  possess 
much  practical  value. 

The  hydrostatic  test,  however,  possesses  great  value, 
and  in  the  hands  of  a  careful  inspector  can  rarely  lead 
to  an  erroneous  conclusion.  It  must  be  remembered, 
however,  that  this  test  is  a  test  of  respiration  and  not  of 

9 


130  MEDICAL   JURISPRUDENCE. 

live  birth  in  the  legal  sense  of  the  term.  In  making 
this  test,  after  securing  the  large  vessels  prior  to  their 
division,  the  heart,  lungs,  and  thymus  gland  should  be 
removed  from  the  chest,  and  the  whole  immersed  in  a 
vessel  sufficiently  large  to  permit  them  freely  to  float  or 
sink,  filled  preferably  with  rain  or  river  water  at  a  tem- 
perature of  about  60°  Fahrenheit.  The  inspector  should 
note  whether  the  parts  collectively  swim  or  sink,  and  if 
the  latter,  whether  the  viscera  reach  the  bottom  quickly 
or  slowly.  The  lungs  should  then  be  detached  from  the 
heart  and  thymus  gland,  and  separately  tried  in  the 
same  way;  they  should  afterwards  be  cut  into  fragments 
and  examined  in  detail  in  the  same  manner,  and  the 
fragments  should  afterwards  be  compressed  so  as  to  ex- 
pel the  air  as  far  as  possible,  and  once  more  tested  in 
the  same  manner.  The  general  conclusion  derived  from 
this  test  is,  that  if  the  lungs  swim,  the  infant  has 
breathed  ;  and  that  if  they  sink,  it  has  not  breathed. 

Gas  in  the  lungs  resulting  from  putrefaction  may  be 
distinguished  from  that  resulting  from  respiration  by 
the  fact  that  the  former  collects  in  large  bubbles,  may 
be  easily  expelled  by  pressure,  and  possesses  a  putrid 
odor ;  whereas  the  contrary  is  the  case  with  gas  in  the 
lungs  resulting  from  respiration,  in  which  case  no  degree 
of  compression  short  of  that  which  will  entirely  break  up 
their  tissues  will  cause  lungs  inflated  naturally  to  sink. 

The  objection  to  this  test,  that  the  lungs  of  the  still- 
born infant  may  be  inflated  artificially  so  as  to  cause 
them  to  float  independently  of  natural  respiration,  does 
not  seem  to  be  in  practice  a  valid  one.  Numerous  at- 
tempts have  been  made  by  medical  jurists  to  expand  the 
lungs  of  still-born  infants  artificially,  and  have  almost 


INFANTICIDE.  131 

without  exception,  entirely  failed.  The  quantity  of  air 
which  may  thus  be  introduced  into  the  lungs  has  been 
found  to  be  inconsiderable ;  and  even  this,  as  it  seems, 
may  be  readily  forced  out  by  compression.  Considering 
the  difficulty  of  making  such  inflation,  the  ignorance  of 
anatomy  of  alleged  criminals  likely  to  resort  to  such  in- 
flation, and  their  want  of  proper  instruments  and  the 
skill  to  use  them,  the  objection  does  not  seem  valid. 
This  examination  should,  however,  in  order  to  be  enti- 
tled to  its  full  weight,  be  made  by  an  inspector  having 
a  competent  knowledge  of  pathological  conditions  which 
may  be  found  in  the  lungs  of  the  new-born  infant ;  for  it 
is  possible  that  the  condition  of  the  lungs  may  be  so 
changed  by  disease  as  to  render  them  specifically  heavier 
than  water.  Such  diseases  are  tubercle,  scirrhus,  pul- 
monary oedema,  sanguineous  congestions,  and  perhaps 
other  conditions  which,  however,  will  be  clearly  mani- 
fested if  the  examination  is  made  by  a  competent 
observer. 

The  cases  of  respiration  before  the  entire  birth  of  the 
child  (vagitus  uterinus  vel  vaginalis)  which  have  already 
been  referred  to  do  not,  when  properly  considered,  in- 
validate the  previous  conclusions ;  for,  as  we  have  already 
stated,  the  hydrostatic  test  is  a  test  of  respiration,  and 
not  of  live  birth  in  the  legal  sense  of  the  term.  These 
cases  are,  moreover,  very  rare,  and  none  of  those  recorded 
were  instances  of  unassisted  or  solitary  labor ;  in  all  of 
these  cases,  either  instruments  or  the  hands  had  been 
introduced,  so  as  to  permit  the  entrance  of  air  into  the 
vagina  or  uterus. 

Besides  the  above  three  tests,  another  test  of  live 
birth  has  been  suggested  by  Dr.  Wreden,  of  St.  Peters- 


132  MEDICAL  JURISPRUDENCE. 

burg.  According  to  him,  the  gelatinous  substance  which 
fills  the  middle  ear  of  the  unborn  infant  gradually  dis- 
appears and  is  replaced  by  air  after  the  establishment  of 
respiration,  and  is  never  encountered  in  the  child  which 
has  lived  for  twenty-four  hours,  although  it  does  not 
entirely  disappear  during  the  first  twelve  hours.  Dr. 
Wendt  of  Leipsic,  and  Dr.  F.  Ogston,  Jr.,  confirm  the 
conclusion  of  Dr.  Wreden,  that  this  substance  can  only 
be  expelled  by  the  establishment  of  full  respiration ; 
but  Dr.  Ogston  found  that  the  time  of  its  disappearance 
varies  from  a  few  hours  to  two  or  three  weeks. 

5.  Lastly,  we  come  to  the  consideration  of  the  causes 
of  the  infants  death.  The  evidences  of  death  in  utcro 
have  already,  in  part,  been  considered  under  the  head  of 
intra-uterine  maceration.  Various  diseases  may  cause 
the  death  of  the  foetus  before  its  birth,  including  dis- 
eases communicated  directly  by  infection  from  the  mother, 
such  as  scrofula,  small-pox,  etc.,  or,  more  remotely,  from 
the  father  through  her,  as  in  syphilis,  which  is  a  very 
fruitful  cause  of  the  death  of  the  foetus.  The  death  of 
the  infant  before  birth  may  also  be  caused  by  mal-for- 
mation  arresting  development,  atrophy,  tuberculosis,  etc. ; 
it  may  also  be  caused  by  falls,  blows,  pressure,  etc.  The 
consideration  of  the  various  diseases,  etc.,  which  may 
cause  the  death  of  the  foetus  belong  more  properly  to 
professed  treatises  on  Obstetrics.  See  also  ante,  chap- 
ter on  ABORTION. 

The  death  of  the  child  may  also  occur  in  a  variety  of 
ways  during  labor,  —  as  from  natural  feebleness  of  con- 
stitution, imperfect  development,  malformation, prematur- 
ity, etc.  Tedious  labor  is  a  fruitful  cause  of  death.  Death 
of  the  child  during  delivery,  where  the  labor  has  been 


INFANTICIDE.  133 

protracted  and  difficult,  is  most  commonly  from  cerebral 
hyperaemia,  apoplexia  neonatorum.  In  these  cases  we 
may  have  congestion  of  the  membranes  of  the  brain  and 
of  the  cerebral  sinuses,  and  extravasations  of  blood  be- 
tween the  pericranium  and  occipital  aponeurosis,  beneath 
the  pericranium,  or  within  the  cranium ;  and  these  ap- 
pearances may  be  so  marked  as  to  account  for  the  death 
of  the  infant,  or  so  slight  as  to  be  compatible  with  its 
recovery.  A  not  uncommon  consequence  of  tedious 
labor,  whether  the  infant  survives  or  not,  is  what  is 
called  caput  siiccedaneum,  which  is  a  sero-sanguinolent 
effusion  under  the  pericranium,  giving  rise  to  a  diffused 
swelling  at  the  seat  of  the  effusion,  located  at  the  parts 
of  the  head  which  are  presented,  most  frequently  over 
one  of  the  parietal  bones.  Sub-pericranial  effusions  of 
blood,  called  cephalhcematomata,  occasionally  result  from 
protracted  labor,  and  are  compatible  with  survival  after 
birth;  they  usually  appear  after  birth,  increase  in  the 
course  of  two  or  three  days  from  the  size  of  a  half-mar- 
ble to  that  of  a  chestnut  or  half  of  a  lien's  egg,  remain 
stationary  for  a  few  days,  and  disappear  slowly  from  a 
month  to  six  weeks  afterwards,  leaving  for  a  time  a 
slight  elevation  of  the  skull  at  the  part.  Prior  to  the 
absorption  of  the  clot,  a  fibrinous  exudation  is  poured 
out  around  the  detached  edge  of  the  pericranium,  dur- 
ing the  subsequent  absorption  of  which  a  process  of  ossi- 
fication sometimes  sets  in,  converting  the  fibrinous  ring 
into  an  osseous  ridge,  while  that  part  of  the  cranium 
over  which  the  clot  has  been  situated  is  roughened  by 
the  formation  of  new  bone  on  its  surface. 

Fractures  of  the  skull  may  occur  during  labor  in  con- 
sequence of  a  relative  disproportion  of  the  head  to  the 


134  MEDICAL  JURISPRUDENCE. 

pelvis,  or  of  the  deformity  of  the  latter.  They  are,  how- 
ever, of  very  rare  occurrence,  and  in  distinguishing  such 
fractures  from  felonious  injuries  to  the  child,  it  should 
be  remembered  that  the  amount  of  violence  done  to  the 
head  by  the  prolicide  is  usually  much  greater  than  is 
encountered  in  cases  of  fractures  during  labor. 

It  should  be  remembered  in  this  connection  that  the 
long  bones  of  the  extremities  of  the  child  are  sometimes 
broken  or  dislocated  in  utero  or  during  delivery. 

Children  sometimes  perish  during  labor  from  the  pre- 
mature arrest  of  the  fcetal  circulation,  which  may  arise 
from  the  detachment  of  the  placenta,  prolapse  of  the 
cord  in  head  presentations,  or  compression  of  it  by  the 
head,  or  by  the  body  or  the  head  in  foot  presenta- 
tions, and  from  the  cord's  becoming  twisted  around  the 
child's  neck  or  limbs,  and  thus  suffering  compres- 
sion. Under  such  circumstances  the  arrest  of  the  cir- 
culation leads  to  instinctive  efforts  on  the  part  of  the 
child  to  breathe,  and  therefore  to  death  by  a  species  of 
asphyxia. 

In  cases  where  the  cord  has  become  twisted  around 
the  child's  neck  during  labor,  thereby  causing  death  by 
asphyxia  or  coma,  in  the  great  majority  of  instances  no 
mark  is  made  on  the  neck  by  the  cord;  exceptional 
cases  are,  however,  recorded  in  which  furrows  and  dis- 
colorations  of  the  skin  have  been  found  at  the  points 
which  have  suffered  compression. 

Among  the  natural  causes  of  the  death  of  the  infant 
subsequent  to  delivery  may  be  mentioned  certain  mal- 
formations incompatible  with  extra-uterine  life ;  and 
immaturity  hindering  its  surviving  birth. 

The  infant  may  die  after  delivery  from  natural  feeble- 


INFANTICIDE.  135 

ness,  or  from  the  presence  of  disease  which  commenced 
before  birth,  such  as  tuberculosis,  syphilis,  etc. 

There  are  recorded  instances,  also,  in  which  the  child 
has  perished  after  delivery  from  occlusion  of  the  mouth 
and  nostrils  by  the  membranes,  where  the  child  and 
membranes  are  suddenly  discharged  en  masse. 

Experiments  by  Dr.  Casper  also  show  conclusively 
that  death  may  be  occasioned  in  consequence  of  a  frac- 
ture of  the  skull  by  the  child's  falling  from  the  genitals 
of  the  woman  in  a  standing  posture,  in  case  of  a  sudden 
or  unexpected  delivery. 

While  it  may  be  that  the  infant  may  perish  after 
delivery  from  the  rupturing  of  the  umbilical  cord  and 
consequent  fatal  hemorrhage  in  cases  of  a  sudden  ex- 
pulsion and  consequent  fall  of  the  infant,  there  do  not 
appear  to  be  any  authenticated  instances  of  such  fatal 
hemorrhages. 

A  child  may  be  smothered  in  the  bedclothes  or  by 
being  overlaid,  either  accidentally  or  criminally;  but 
there  are  no  means  of  distinguishing  the  one  case  from 
the  other.  The  child  may  also  after  birth  perish  by  its 
face  falling  into  the  mother's  discharges,  or  by  being 
accidentally  dropped  into  a  privy  when  labor  has  come 
on  suddenly  at  stool. 

Criminal  practices  against  the  life  of  an  infant  are 
usually  perpetrated  at  the  conclusion  of  labor.  It  will 
often  be  impossible  in  practice  to  distinguish  those  cases 
where  the  death  of  the  child  has  arisen  from  want  of 
suitable  warmth  or  nourishment,  absence  or  unsuita- 
bility  of  the  ligatures  of  the  cord,  etc.,  where  it  is 
accompanied  with  a  criminal  intent,  from  cases  where 
there  is  no  criminal  intent. 


136  MEDICAL  JURISPRUDENCE. 

The  life  of  the  infant  has  been  destroyed  by  punctures 
of  the  fontanelles,  of  the  orbit,  nucha,  twisting  of  the 
neck  after  delivery  of  the  head,  strangulation,  and 
wounds  inflicted  through  the  several  inlets  and  outlets 
of  the  body.  The  body  of  the  infant  whose  death  is 
suspected  to  have  been  caused  by  criminal  violence 
should  be  carefully  inspected  for  such  injuries.  Death 
may  also  be  caused  by  strangulation,  blows  or  injuries 
about  the  head,  incised  wounds,  drowning,  suffocation, 
smothering,  etc.  The  appearances  characteristic  of  death 
thus  caused  will  be  found  discussed  in  the  chapters  upon 
WOUNDS,  DROWNING,  STRANGULATION,  etc. 

In  a  case  of  death  by  drowning,  unless  the  child  had 
lived  long  enough  to  have  established  respiration,  this 
mode  of  death  would  leave  no  traces  on  the  body. 

In  cases  of  suspected  poisoning  of  new-born  infants, 
it  should  be  remembered  that  the  internal  surface  of 
the  oesophagus  is  often  injected  in  new-born  children 
after  death,  such  injection  assuming  the  form  of  ramifi- 
cation of  vessels  or  of  longitudinal  striae,  which  might 
be  mistaken  for  the  effects  of  certain  irritant  poisons. 

Ulcerations  of  the  stomach,  attended  with  the  collec- 
tion of  a  brown  or  blackish  bloody  fluid,  are  sometimes 
also  discovered,  which  might  give  rise  to  a  suspicion  of 
poisoning.  Similar  appearances  have  also  been  found 
in  the  intestines,  thus  affording  sufficient  data  by  which 
to  account  for  the  death  of  the  child  from  natural 
causes. 

We  cannot  better  close  this  chapter  than  by  giving 
Dr.  Ogston's  method  of  making  an  inspection  of  the 
body  of  an  infant  suspected  to  have  been  the  victim  of 
foul  play.  The  medical  jurist,  says  he,  ought  at  the 


INFANTICIDE.  137 

outset  to  make  himself  acquainted  with  all  the  partic- 
ulars of  the  case, —  the  place  where  the  child  was  found, 
the  circumstances  attending  its  removal  thence,  and 
the  facts  relative  to  the  suspected  party  if  suspicion 
rests  upon  any  one.  He  should,  if  possible,  visit  the 
place  where  the  body  was  discovered ;  he  should  then 
examine  the  wrappings  of  the  child,  if  there  are  any  ; 
the  marks  upon  them,  if  any ;  the  thread  with  which 
they  had  been  sewed ;  character  of  the  ligature,  if  any, 
around  the  cord,  etc.  In  this  way  the  mother  may 
sometimes  be  discovered. 

These  preliminaries  having  been  attended  to,  the 
examiner  should  proceed  to  the  external  inspection  of 
the  infant's  body,  noting  — 

1.  Its  general  conformation,  and  especially  any  defect 
or  vice  which  might  effect  its  viability. 

2.  Its  degrees  of  freshness  or  putridity. 

3.  The  color  of  the  skin. 

4.  The  degree  of  adhesion  of  the  cuticle  and  of  the 
nails. 

5.  The   extent  of  the  saponification   if  it  has   com- 
menced, or  of  the  emphysema  if  gases  are  generated 
under  the  skin,  etc. 

6.  The  natural  openings  should  be  examined  as  to 
their  being  pervious  or  otherwise,  with  the  discharges 
which  may  have  proceeded  from  them. 

7.  If  any  punctures,  incised  wounds,  contusions  or 
ecchymoses   exist,   their  situation,   extent,   and   depth 
should  be  especially  noted. 

8.  The  body  should  be  weighed  and  measured,  ob- 
serving with  what  point  of  the  abdomen  the  centre  of 
its  length  corresponds. 


138  MEDICAL  JURISPRUDENCE. 

9.  The   state   of   the   navel   should   be   particularly 
attended  to,  observing  if  any  part  of  the  cord  remains 
attached  to  the  belly,  whether  it  is  fresh  or  shrivelled 
and  dry,  or  free  or  not  from  inflammation  and  vascu- 
larity;  whether  it  is  spare  or  plump;  whether  it  has 
been  tied  or  not;  if  tied,  at  what  distance  from  the 
navel ;  the  degree  of  torsion  of  the  remains  of  the  cord ; 
its  translucence,  the  volume  and  course  of  its  vessels,  if 
they  contain  blood  or  if  any  can  be  expressed  from 
them ;  whether  it  has  been  cut  through  or  torn,  and  if 
the  former,  whether  with  a  blunt  or  sharp  instrument. 

10.  If  the  placenta   is  found,   the  divided  ends  of 
the  cord  should  be  compared  to  see  if  they  correspond, 
and  the  length  of  the  remains  of  the  cord,  both  placental 
and  foetal,  should  be  measured. 

11.  The  sebaceous  coating,  if  present,  should  be  looked 
for  chiefly  in  the  arm-pits,  groins,  and  hands ;  its  pres- 
ence shows  that  no  care  had  been  taken  by  washing 
for  the  child's  preservation. 

12.  The  hairs  should  be  noted  as  to  their  color,  length, 
and  quantity. 

This  external  general  inspection  completed,  the  ex- 
aminer should  proceed  to  the  special  inspection,  begin- 
ning with  — 

1.  The  head,  —  ascertaining  its  form  and  dimensions 
in  different  directions ;  carefully  removing  the  hairs  and 
examining  the  scalp ;  dividing  the  scalp  by  a  crucial 
incision,  or  from  ear  to  ear ;  ascertaining  the  state  of 
the  internal  surface  of  the  scalp,  of  the  bones  and 
sutures,  and  the  size  and  appearance  of  the  fontanelles ; 
removing  the  skull-cap  in  the  usual  direction  with  a 
pair  of  stout  scissors ;  examining  the  brain  in  situ,  and 


INFANTICIDE.  139 

removing  it  along  with  the  medulla  oblongata  in  order 
to  inspect  the  top  of  the  spine  and  the  base  of  the 
skull. 

2.  The  front  of  the  neck  should  then  be  attentively 
looked  at  for  any  grooves  caused  by  ligatures,  ecchy- 
moses  or  abrasions,  after  which  the  larynx  and  verte- 
bral column  may  be  inspected. 

3.  The  cavity  of  the  mouth  should  now  be  laid  open 
to  ascertain  if  any  plug  had  been  introduced  and  left 
there,  or  if  any  traces  of  irritants  or  corrosives  appear. 

4.  To  ascertain  the  state  of  the  chest,  the  clavicles 
should  be  divided  with  a  pair  of  scissors,  avoiding  the 
subclavian  vessels,  and  afterwards  the  cartilages  of  the 
ribs,  folding  down  the  sternum  and  leaving  it  attached 
to  the  abdominal  parietes.     The  situation  and  volume 
of  the  pectoral  viscera  can  now  be  noted,  as  well  as  the 
state  of  fulness  or  vacuity  of  their  vessels.     It  should 
now  be   observed  whether  the   lungs   cover  the  peri- 
cardium  or  lie   unexpanded  and  deep  in   the  chest; 
whether   their   margins   are   sharp   or  rounded ;   what 
is   their   color  and   consistence ;    whether   uniform   or 
mottled ;  whether  their  capillaries  are  injected  or  not ; 
whether    they   are    fresh,   emphysematous,    or    putrid. 
Their  appearance  can  be  compared  with  that   of  the 
thymus  gland  and  the  appearance  of  that  gland  noticed. 
The  pericardium  should  now  be  opened  and  its  appear- 
ances, externally  and  internally,  examined  ;  the  thymus 
gland  turned  up,  the  left  lung  being  pushed  to  the  right, 
and  the  state  of  the  ductus  arteriosus  ascertained.    After 
the  application  of  double  ligatures  to  the  vence  caves,  the 
aorta,  pulmonary  artery,  and  the  trachea,  the  lungs  and 
thymus  gland  should  be  removed  from  below  upwards, 


140  MEDICAL  JURISPRUDENCE. 

and  the  hydrostatic  test  applied.  The  heart  should 
next  be  opened  to  ascertain  the  quantity  and  distribu- 
tion of  the  blood  in  its  interior  and  the  state  of  the 
foramen  ovale.  The  heart,  lungs,  and  thymus  gland 
should  then  be  separated  from  each  other, — after  secur- 
ing their  connecting  vessels  with  double  ligatures,  —  the 
lungs  weighed,  and  their  weight  compared  with  that  of 
the  body.  Note  whether  they  sink  or  float  —  whether 
in  whole  or  in  part,  and  whether  buoyantly  or  not  — 
when  thrown  into  water ;  and,  after  cutting  them  into 
fragments,  what  portions  sink  and  what  float;  if  the 
former,  whether  they  are  sound  or  diseased,  and  what  the 
disease,  if  any.  On  handling  and  cutting  the  lungs,  it 
should  be  observed  whether  they  have  a  spongy  or  solid 
feeling,  and  whether  they  crepitate  or  not.  By  com- 
pressing the  fragments  in  air,  the  amount  of  blood  or 
other  fluids  which  they  may  contain  can  be  ascer- 
tained ;  while  by  doing  so  under  water,  the  presence 
or  absence  of  air  can  be  discovered ;  and  if  they  con- 
tain air,  the  size  of  the  air  bubbles  given  out  will  assist 
in  the  discrimination  as  to  whether  it  was  contained  in 
the  air  cells  or  in  the  subpleural  or  interlobular  areolar 
tissue,  and  their  odor  if  fetid  will  serve  to  characterize 
putrid  lungs. 

5.  The  best  mode  of  opening  the  abdomen  so  as  not 
to  interfere  with  the  umbilical  vessels  is  to  remove  the 
sternum  at  the  base  of  the  chest,  to  carry  an  incision 
from  the  xyphoid  or  ensiform  cartilage  to  a  point  a  little 
above  the  umbilicus,  to  prolong  the  incision  downwards 
and  outwards  at  a  little  distance  from  the  navel  to  the 
anterior  superior  spinous  process  of  the  ilium,  and  thence 
across  the  pubes  to  meet  the  continued  incision  on  the 


INFANTICIDE.  141 

opposite  side.  The  examiner  should  now  search  the 
abdomen  for  effused  blood  and  sanguinoleut  serum  or 
other  effused  fluids ;  for  marks  of  putrefaction ;  for 
ruptures  of  the  liver,  or  ecchymoses  indicative  of  effused 
blood  in  its  interior  ;  for  rupture  or  softening  of  the 
spleen.  The  state  of  the  umbilical  vessels  should  be 
noted,  whether  open  or  contracted,  full  or  empty ;  the 
state  of  the  stomach,  whether  it  contains  milk  or  other 
alimentary  matters,  or  mucus  containing  air  bubbles  ; 
and  in  what  part  of  the  intestines  the  meconium,  if 
present,  is  to  be  found,  or  if  they  contain  air.  The  ex- 
ploration of  the  bladder,  kidneys,  and  genitals,  external 
and  internal,  complete  this  part  of  the  examination. 

6.  The  spine  should  be  explored  throughout. 

7.  To  complete   the  inspection,  it  only  remains  for 
the  examinator  to  ascertain  whether  any  ecchymoses 
exist  on  the  trunk  or  limbs,  for  this  purpose  making 
free  incisions  in  the  latter;  and  to  turn  his  attention 
to  the  bones  in  order  to  ascertain  the  state  of  their 
development. 

See  the    chapters  on  MEDICO-LEGAL    INSPECTIONS, 
LEGITIMACY  AND  PATERNITY,  and  PERSONAL  IDENTITY. 


CHAPTER  XII. 

DEFLORATION  AND   RAPE;   SODOMY. 

Definitions,  etc.  —  By  "  defloration  "  is  meant  the  act 
of  depriving  a  female  of  her  virginity ;  and  by  "  rape  "  is 
meant  carnal  knowledge  of  a  woman  by  force  and 
against  her  will.  Cases  of  the  former  will  seldom  come 
before  the  medical  jurist. 

The  age  of  consent  by  the  common  law  is  fixed  at 
twelve  years ;  this  age  has,  however,  been  variously 
changed  by  statute  to  ages  from  ten  to  fourteen  years. 
Carnal  knowledge  of  a  child  under  the  age  of  consent 
also  constitutes  the  crime  of  rape,  a  child  of  such  ten- 
der years  being  considered  incapable  of  giving  a  legal 
consent.  According  to  the  doctrine  of  the  common 
law,  a  boy  under  fourteen  is  incapable  of  committing 
rape  whatever  may  be  his  physical  capacity.  In  the 
State  of  Ohio,  however,  this  doctrine  has  not  been 
adopted  ;  in  that  State  a  boy  under  the  age  of  fourteen 
is  prima  facie  incapable  of  committing  this  offence, 
but  on  proof  of  the  existence  of  such  capacity,  he  may 
be  convicted  of  this  crime.  The  same  point  has  also 
been  ruled  in  the  Supreme  Court  of  New  York,  but 
does  not  seem  to  have  been  adopted  elsewhere. 

By  the  law  as  it  at  present  exists  both  in  England 
and  in  this  country,  emission  is  not  necessary  to  the 


DEFLORATION  AND  RAPE;    SODOMY.  143 

complete  commission  of  this  offence.  Penetration  is, 
however,  necessary;  but  both  the  English  and  the 
American  courts  hold  that  nothing  more  is  required 
than  res  in  re,  without  regard  to  the  extent  of  penetra- 
tion ;  and  according  to  the  prevalent  doctrine,  mere 
vulvar  penetration  is  sufficient, —  the  fact  of  the  hymen's 
not  being  ruptured  being  only  presumptive  evidence 
against  penetration. 

Without  entering  into  the  consideration  of  the  legal 
aspects  of  this  offence,  which  more  properly  belongs  to 
a  treatise  upon  the  criminal  law,  it  is  proper  in  this 
connection  to  consider  the  subject  under  three  heads  : 

1.  Violation  of  the  female  under  the  age  of  puberty. 

2.  Violation  of  the  female  after  puberty  but  prior  to 
her  having  otherwise  had  sexual  intercourse. 

3.  Violation  after  puberty  and  where  the  female  has 
been  accustomed  to  such  intercourse. 

Before  entering  into  the  consideration  of  these  three 
topics,  it  may  perhaps  be  well  to  state  the  physical 
signs  of  virginity.  No  female  should  be  examined  for 
the  purpose  of  ascertaining  whether  or  not  she  is  a 
virgin  during  the  period  of  menstruation.  The  physical 
signs  indicating  virginity  are,  — 

1.  The  presence  of  an  intact  hymen,  which  is  a  mem- 
brane stretched  across  the  entrance  to  the  vagina,  in 
which  there  is  an  opening  towards  the  orifice  of  the 
urethra.  This  opening  may  assume  a  variety  of  forms, 
as  that  of  an  irregular,  circular  diaphragm  broken  at  its 
upper  third  or  in  some  cases  perforated  by  a  central 
opening ;  or,  which  is  its  most  common  appearance,  it 
may  consist  of  a  semi-circular  fold  of  integument 
stretched  across  the  lower  border  of  the  vaginal  orifice, 


144  MEDICAL  JURISPRUDENCE. 

the  free  border  concave  and  notched  and  its  extremities 
losing  themselves  in  the  labia  minora.  It  sometimes 
assumes  other  forms,  such  as  a  complete  septum  pierced 
by  numerous  minute  openings ;  and  there  are  recorded 
instances  of  its  being  imperforate  and  completely  block- 
ing the  entrance  to  the  vagina.  Its  normal  condition  is 
such  as  to  permit  the  passage  of  the  finger  into  the 
vagina  without  injuring  its  border  of  mucous  mem- 
brane ;  and  there  would  seem  to  be  no  doubt  that  if 
this  aperture  was  slightly  larger  than  usual,  and  the 
male  organ  small,  repeated  intercourse  may  be  had  with- 
out rupturing  it  or  without  other  change  than  an  in- 
creased dilatability  of  the  aperture,  or  perhaps  minute 
tears  or  indentations  on  its  free  border.  In  some 
females  the  hymen  may  be  in  so  relaxed  a  state,  by 
the  discharges  of  leucorrhcea  or  otherwise,  as  to  dimin- 
ish its  liability  to  rupture  by  sexual  intercourse.  If, 
however,  the  aperture  is  small,  it  will  almost  always  be 
ruptured  by  the  first  coitus.  There  are  recorded  cases, 
however,  where  an  unruptured  hymen  has  continued 
throughout  pregnancy  and  has  not  been  ruptured  until 
delivery.  Dr.  Lusk  records  the  case  of  a  young  woman, 
nineteen  years  of  age,  who  possessed  a  perfect  hymen, 
the  opening  of  which  was  of  the  ordinary  size,  yet  so 
distensible  was  its  tissue  that  a  one  inch  speculum  was 
repeatedly  introduced  for  purposes  of  examination  with- 
out in  the  slightest  degree  affecting  its  integrity.  There 
is  said  to  be  in  Meckel's  museum  at  Halle,  a  specimen 
of  the  female  genitals  where  the  hymen  is  perfect  al- 
though the  woman  had  given  birth  to  a  seven  months' 
child.  Dr.  Lusk  states  that  in  his  experience,  however, 
in  the  examination  of  young,  nulliparous  prostitutes  for 


DEFLORATION  AND  RAPE;   SODOMY.  145 

uterine  disorders,  he  has  always  found  a  torn  hymen, 
but  in  no  case  carunculce  myrtiformes. 

Although  the  existence  of  the  hymen  in  any  case  has 
even  been  doubted  by  some  writers,  there  can,  we  think, 
be  no  doubt  of  its  constant  existence  at  some  period. 
With  respect  to  this  subject  Casper  makes  the  state- 
ment that  when  a  forensic  physician  finds  a  hymen  still 
preserved,  even  its  edges  not  being  torn,  and  along  with 
it  a  virgin  condition  of  the  breasts  and  external  genitals, 
he  is  then  justified  in  giving  a  positive  opinion  as  to 
the  existence  of  virginity. 

While  not  prepared  to  indorse  so  strong  an  opinion 
as  this  to  its  fullest  extent,  still  such  a  condition  —  espe- 
cially if  the  aperture  is  small,  and  the  membrane  un- 
dilatable  and  of  ordinary  shape  and  structure  and  nor- 
mally placed  —  is  without  doubt  strong  evidence  of 
virginity,  though  perhaps  not  absolutely  conclusive. 
Notwithstanding  this,  however,  the  presence  of  an  in- 
tact hymen  must  not  be  considered  as  conclusive  proof 
that  rape  has  not  been  committed,  especially  consider- 
ing the  fact  that  the  crime  may  be  completed  by  simple 
vulvar  penetration.  It  should  also  be  remembered  that 
in  children  this  membrane  is  more  deeply  placed  than 
in  the  adult,  and  can  only  be  readily  seen  in  them  on 
the  forcible  separation  of  the  thighs. 

Although  the  presence  of  an  unruptured  hymen  in  a 
female  arrived  at  puberty  is  very  strong  evidence  of 
virginity,  it  may  be  destroyed  by  surgical  operations, 
by  a  medical  examination  of  the  genital  organs,  by 
self-abuse,  and  by  various  other  forms  of  mechanical 
violence.  It  has  even  been  alleged  that  riding,  danc- 
ing, and  leaping  may  in  exceptional  cases  destroy  it,  — 

10 


146  MEDICAL  JURISPRUDENCE. 

allegations,  however,  which,  considering  the  location  of 
the  hymen,  are  in  our  opinion  to  be  received  with  con- 
siderable scepticism. 

2.  The    absence    of    the   carunculce  myrtiformes   is 
usually  regarded  as  evidence  of  virginity.     Two  or  more 
of  these  are  vaginal ;  the  others  —  which  are  hymeneal, 
aud  are  the  remains   of  the  ruptured   hymen  —  only 
prove  the  rupture  of  the  hymen,  and  furnish  no  evidence 
as  to  the  cause  of  its  rupture. 

3.  The  entirety  of  the  fourchette,  fossa  navicularis, 
and  posterior  commissure  of  the  labia,  are  regarded  by  . 
some  as  another  evidence  of  virginity.     Of  these  it  may 
be  said  that  while  they  seldom  survive  the  first  labor 
at  term,  they  are  not,  as  a  rule,  affected  by  sexual  in- 
tercourse  unless   under  circumstances  of  considerable 
violence ;   so  that  while  destruction  may  be   evidence 
of  prior  delivery  or  at  least  of  the  passage  of  some  large 
body  through  the  genital  passages,  their  presence  fur- 
nishes very  little  evidence  of  virginity. 

4.  A  narrow  and  rugose  state  of  the  vagina  is  some- 
times considered  a  mark  of  virginity.     It  not  unfre- 
quently,   however,   exists    in   young,   healthy  married 
women  prior  to  child-bearing,  and  is  not  always  oblit- 
erated after  a  single    confinement    at    an   early   age. 
Mere  sexual  intercourse,  unless  under  circumstances  of 
great  violence,  would  not  alter  its  condition ;  while  on 
the  other  hand  leucorrhrea  or  other  pathological  condi- 
tions might  destroy  this  condition  in  females  who  had 
never  had  sexual  intercourse. 

5.  A  plump  and  elastic  condition  of  the  breasts,  with 
slight  development  only  of  the  nipples,  is  mentioned  by 
medical  jurists  as  another  evidence  of  virginity.     The 


DEFLORATION  AND  RAPE;  SODOMY.  147 

areola  is  altered  by  conception,  but  not  by  mere  sexual 
intercourse ;  and  although  the  breasts  may  be  slightly 
affected  by  constant  intercourse,  and  considerably  so  by 
advancing  age  and  feeble  general  health,  the  evidence 
of  virginity  afforded  by  their  general  condition  would 
seem  to  be  very  slight. 

6.  The  integrity  of  the  perinceum,  while  always  found 
in  virgins,  is  not  affected  by  sexual  intercourse  unless 
accompanied  by  great  violence ;  and  is  therefore  of  very 
little  value  as  an  evidence  of  virginity.     It  is,  however, 
almost  always  slightly  lacerated  in  first  labor. 

7.  In  healthy  virgin  females  before  the  decline  of  life, 
the   labia  are   usually  bulky,  smooth,  vermilion-hued, 
elastic,  and  in  contact  with  each  other,  concealing  the 
orifice   of  the  vulva  entirely ;   and  the   nymphse   are 
smaller  in  proportion  in  a  virgin  state  of  the  genitals, 
and  lie  more  concealed  by  the  labia  when  the  thighs 
are    nearly  in   contact.      Nevertheless,   indulgence   in 
libidinous  desires   and  manipulations  would  doubtless 
produce  in  them  a  similar  effect  to  that  produced  by 
sexual  intercourse.     The  normal  size  and  condition  of 
the  clitoris  affords  a  presumption  of  virginity ;  and  its 
enlargement,   facility   of  erection,  and   the  laxity  and 
mobility  of  its  prepuce,  raises  a  presumption  of  non- 
virginity.     But  here,  again,  it  should  also  be  remembered 
that  the   practices  above  referred  to  may  produce  the 
same  as  or  greater  changes  than  sexual  intercourse. 

The  concurrence  of  all  these  physical  signs  of  vir- 
ginity affords  strong  evidence  of  this  condition ;  and  yet 
it  behooves  the  medical  jurist  to  be  very  careful  in  ex- 
pressing a  decided  opinion  upon  this  subject ;  for  there 
is  a  recorded  instance  of  a  common  prostitute's  preserv- 


148  MEDICAL  JURISPRUDENCE. 

ing  so  many  of  the  signs  of  virginity  that  a  very  able 
physician  after  a  careful  examination  was  unable  to 
determine  whether  or  not  she  was  a  virgin. 

1.  Coming  to  the  first  of  the  divisions  above  indi- 
cated, namely,  violation  of  the  female  under  the  age  of 
puberty,  in  such  cases  extensive  marks  of  local  injury 
should  be  looked  for,  and  in  their  absence  it  cannot  be 
admitted  that  complete  coition  has  taken  place.  This 
will  be  evident  when  we  consider  the  undeveloped  state 
of  the  sexual  organs  in  the  female  at  this  age,  and  the 
disproportion  between  the  adult  penis  and  the  narrow 
canal  of  the  vagina.  Instances  are  sometimes  met  with 
of  violence  produced  in  this  way  on  children  so  serious 
as  to  prove  fatal  to  life.  In  one  case  recorded  by  Dr. 
Ogston,  a  post-mortem  examination  disclosed  the  ex- 
ternal organs  of  generation  and  the  perinseum  torn  and 
violently  inflamed,  the  vagina  torn  away  from  the 
uterus,  and  a  large  rent  in  the  peritoneum,  with  bloody 
fluid  effused  into  the  abdominal  cavity.  Injuries  of  all 
degrees  may  be  inflicted  between  this  extreme  and  the 
other  extreme  of  mere  vulvar  penetration  without  en- 
trance into  the  vagina  and  injury  to  the  hymen  ;  in  the 
latter  case  there  may  be  no  trace  of  violence,  but  the 
crime  may  be  complete,  in  the  legal  sense,  in  the  entire 
absence  of  marks  of  injury  about  the  external  genitals. 
In  the  simpler  cases  there  may  be  slight  irritation  of 
the  vulva,  characterized  by  heat  and  moderate  redness 
of  the  parts ;  more  frequently,  however,  there  will  be 
swelling  and  contusion  of  the  labia,  intense  redness  of 
the  hymen  and  vaginal  outlets,  and  the  whole  of  these 
parts  will  be  so  painful  as  to  make  any  examination  of 
them  difficult,  if  not  impossible.  Excoriations,  super- 


DEFLORATION  AND   RAPE;   SODOMY.  149 

ficial  erosions,  and  even  real  ulcerations  are  not  unusual. 
In  this  connection  it  should  be  remembered  that  diseases 
of  the  genitals  occasionally  occur  in  female  children 
which  unless  care  is  used  may  be  confounded  either 
with  the  effects  of  local  violence  or  with  venereal  dis- 
ease. One  form  of  such  local  disease  in  young  females 
consists  of  a  purulent  discharge  from  the  genitals  closely 
resembling  gonorrhoea.  A  muco-purulent  vaginal  dis- 
charge will  probably  be  found  within  a  few  hours  after 
a  rape  upon  a  young  girl ;  this  discharge  is  not  goiior- 
rhoeal  but  results  from  the  inflammation  arising  from  the 
irritation  of  connection.  It  is  usually  at  first  bloody, 
but  rapidly  changes  to  a  greenish  tint,  finally  becoming 
glutinous  ;  it  is  commonly  attended  with  great  smarting 
and  with  constant  desire  to  scratch  the  genitals ;  but 
the  existence  of  such  a  discharge,  although  it  is  impor- 
tant evidence,  is  not  proof  of  rape.  It  is  a  well-known 
fact  that  the  majority  of  females,  whether  virgins  or  not, 
suffer  at  times  from  leucorrhoea ;  while  in  the  case  of 
female  infants  and  young  children  inflammation  of  the 
vulva  and  of  the  vagina,  giving  rise  to  infantile  leu- 
corrhoea, is  common.  It  is  generally  considered  that 
there  are  no  certain  diagnostic  signs  by  which,  under  all 
circumstances,  such  discharges  may  be  distinguished 
from  leucorrhoea,  unless  it  be  by  a  pure  culture  and 
microscopic  examination  for  the  discovery  of  the  so- 
called  gonococcus ;  but  in  the  present  state  of  our 
knowledge,  the  specific  nature  of  this  so-called  gono- 
coccus, while  probable,  can  hardly  be  said  to  be  proved. 

Another  severe  form  of  genital  inflammation  some- 
times found  in  young  children,  and  which  terminates 
in  a  destructive  and  gangrenous  form  of  ulceration  is 


150  MEDICAL  JURISPRUDENCE. 

the  disease  called  noma,  which  might  be  mistaken  for  the 
results  of  attempted  violation.  A  further  description  of 
this  disease  is  beyond  the  scope  of  this  treatise. 

Light  may  be  thrown  upon  the  case  by  a  careful  in- 
quiry as  to  the  time  when  the  discharge  first  appeared  ; 
for  if  gonorrhoea  or  syphilis  be  clearly  marked  in  the 
female  at  the  time  of  the  examination,  and  such  exam- 
ination has  been  conducted  immediately  after  the  al- 
leged rape,  it  may  be  considered  as  certain  that  the 
venereal  disease  did  not  result  from  the  alleged  rape  ;  for 
both  gonorrhoea  and  syphilis  have  a  distinct  period  of 
incubation,  which  in  the  former  disease  varies  from 
some  hours  to  three  or  four  days  or  even  more,  and  in 
the  latter  from  ten  to  forty-four  days  or  even  longer. 
The  existence,  therefore,  of  a  profuse  discharge  a  few 
hours  after  an  alleged  rape,  or  of  secondary  or  tertiary 
symptoms  soon  after,  would  be  almost  conclusive  evi- 
dence that  the  disease  was  contracted  prior  to  the 
alleged  rape. 

It  must  also  be  remembered  that  this  disease  may  have 
resulted  from  other  causes  than  intercourse,  and  hence 
if  sufficient  time  has  elapsed  for  the  development  of  the 
disease,  the  existence  of  the  disease  is  not  very  strong 
evidence  of  the  commission  of  the  crime.  If  an  exam- 
ination of  the  male  shows  that  he  has  not  either  of  said 
diseases,  of  course  this  is  strong  exculpatory  evidence ; 
if  on  the  other  hand  he  is  found  suffering  from  the  same 
disease  as  the  female,  this  may  be  evidence  against  him. 

2.  Coming  now  to  the  subject  of  the  defloration  or 
violation  of  a  virgin  after  puberty,  it  may  be  Stated  at 
the  outset  that  the  proof  of  such  violation  by  medical 
evidence  is  much  more  difficult  than  in  the  case  of 


DEFLORATION  AND  RAPE;   SODOMY.  151 

children.  In  order  to  establish  the  offence  in  such 
cases  there  must  be  evidence  — 

a.  That  previous  connection  with  another  person 
could  not  have  taken  place. 

&.  That  the  alleged  intercourse  took  place  at  the  time 
alleged. 

c.  That  it  was  by  force  and  against  the  will  of  the 
woman. 

The  evidence  bearing  upon  the  first  point  has  already 
been  considered  at  the  beginning  of  this  chapter,  under 
the  heading,  physical  signs  of  virginity. 

As  to  the  two  other  points,  where  both  parties  are 
above  the  age  of  puberty,  and  the  penis  of  the  male  is 
disproportionately  large  as  respects  the  female,  a  recent 
connection,  when  it  has  been  fully  effected,  will  produce 
effects  in  the  female  the  same  in  kind,  though  less  in 
degree,  as  in  the  case  already  considered.  This  dispro- 
portion may  exist  where  the  male  is  in  the  vigor  of 
manhood,  and  the  female  just  past  the  age  of  puberty, 
and  her  sexual  organs  not  yet  fully  developed.  It  may 
also  exist  where  both  parties  are  of  mature  age,  but  the 
male  is  large  and  vigorous,  and  the  female  small  or  not 
so  fully  developed.  In  such  cases  the  following  ap- 
pearances may  be  encountered,  namely:  bruising  and 
excoriation  of  the  clitoris  and  labia ;  laceration  of  the 
mucous  membrane  of  the  external  parts,  with  ecchymo- 
ses  under  the  membrane ;  vascular  injection  in  the 
vicinity  of  the  excoriations ;  rupture  of  the  hymen  and 
sometimes  of  the  fourchette,  and  even  excoriation  of  the 
lining  membrane  of  the  vagina  within  its  external  ori- 
fice. Besides  these,  the  vulva  may  be  swollen,  tender 
and  painful  to  the  touch,  while  the  chemise  may  be 


152  MEDICAL  JURISPRUDENCE. 

stained  in  front  with  seminal  fluid,  and  behind  and  in 
front  with  blood.  These  appearances  may  sometimes 
present  themselves  to  some  extent  where  the  venereal 
congress  has  been  entirely  voluntary  on  the  part  of 
both,  especially  where  the  parties  have  been  actuated 
by  strong  and  ungovernable  desire.  These  appearances 
of  the  genitals  must  be  looked  for  early;  in  almost 
every  instance  they  will  have  become  obliterated  by  the 
third  or  fourth  day,  by  which  time  the  lacerations  will 
have  healed  and  the  torn  hymen  be  in  such  a  state  as 
to  make  it  difficult  to  say  whether  it  has  been  ruptured 
recently  or  at  an  earlier  period. 

In  the  cases  above  described  the  male  has  been  sup- 
posed to  be  more  vigorous  and  fully  developed  than  the 
female ;  when,  however,  the  parties  are  more  nearly 
equal  in  this  respect  the  effects  of  a  first  connection 
will  be  likely  to  be  much  less  noticeable,  though  some 
of  them  will  probably  be  found.  When  the  genital 
organs  of  the  female  have  become  relaxed  by  long  con- 
tinued leucorrhceal  discharges,  profuse  menstruation,  ad- 
vanced age  or  other  causes,  the  signs  of  recent  defloration 
will  be  still  more  faint. 

It  should  be  remembered  that  local  injuries  such  as 
those  which  may  be  produced  by  first  coitus,  and  those 
which  may  be  caused  by  the  forcible  introduction  of 
foreign  bodies,  cannot  with  certainty  be  distinguished ; 
and  that  there  are  recorded  instances  in  which  such  in- 
juries have  been  produced  by  the  assailant  not  in  the 
usual  way,  but  by  other  means  than  by  the  introduction 
of  his  penis.  These  questions  must  be  solved  by  the 
ordinary  rules  of  evidence. 

The  subject  of  seminal  and  blood  stains  which  have 


DEFLORATION  AND  RAPE;   SODOMY.  153 

already  been  referred  to,  as  well  as  marks  of  bruises, 
scratches,  etc.,  will  be  further  considered  post. 

3.  Coming  now  to  the  third  division,  namely,  where 
the  female  is  known  to  have  been  accustomed  to  sexual 
intercourse,  it  may  be  stated  that  the  proof  in  these 
cases  must  usually  be  made  out  by  the  application  of 
the  ordinary  rules  of  evidence,  and  usually  little  assist- 
ance can  be  rendered  by  the  medical  jurist.  Of  course 
the  signs  of  virginity  and  of  defloration  are  not  elements 
of  the  inquiry. 

It  should  be  remembered,  however,  that  in  these 
cases,  where  the  disproportion  between  the  bulk  of  the 
penis  and  the  size  of  the  vagina  is  very  great,  the  ap- 
pearances above-described  may  to  a  greater  or  less  ex- 
tent be  produced  even  where  the  woman  is  not  a  virgin ; 
especially  may  this  happen  where  the  intercourse  is 
effected  with  brutality,  or  where  several  men  in  suc- 
cession have  forcibly  had  connection  with  the  same 
woman.  In  this  class  of  cases,  as  well  as  in  children 
and  virgins,  bruises,  scratches,  or  other  injuries  of  the 
person  will  often  be  met  with.  Seminal  stains  will 
probably  be  found,  and  venereal  disease  may  follow  the 
intercourse.  The  evidence,  however,  to  be  derived  from 
the  existence  of  venereal  disease  is  much  less  trust- 
worthy than  in  the  cases  previously  described.  It  is  not 
necessary  in  this  connection  to  add  anything  to  what 
has  been  said  upon  this  subject.  In  either  of  the  last 
two  cases  pregnancy  may  result  from  the  alleged  rape ; 
but  in  the  case  of  married  women  or  women  living  in 
adultery  the  evidence  afforded  by  such  impregnation 
will  of  course  be  of  no  value. 

Blood-stains  on  women  who  are  accustomed  to  sexual 


154  MEDICAL  JURISPRUDENCE. 

intercourse  will  not  be  found  unless  the  intercourse  is 
effected  under  circumstances  of  exceptional  brutality. 

There  are  recorded  instances  of  sexual  intercourse 
having  been  had  with  a  woman  during  a  deep  sleep, 
without  her  having  been  conscious  of  the  fact.  Where 
the  woman  has  been  accustomed  to  sexual  intercourse, 
or  where  the  sleep  is  pathological  or  induced  by  drugs, 
this  is  not  impossible ;  but  that  intercourse  may  have 
been  had  during  natural  sleep  with  a  woman  not  accus- 
tomed to  sexual  intercourse,  or,  as  a  rule,  even  with  a 
woman  so  accustomed,  is  not  to  be  believed  except  upon 
the  most  conclusive  evidence.  There  is  one  recorded 
case  where  rape  was  committed  upon  a  woman  in  a 
state  of  mesmeric  coma. 

The  allegation  is  sometimes  made  in  cases  of  alleged 
rape  that  the  accused  exhibited  chloroform  upon  a 
handkerchief  to  the  woman,  who  thereupon  instantly 
became  unconscious.  Such  allegations  are  entirely  op- 
posed to  universal  experience  and  are  not  to  be  believed. 
Experiments  have  been  made  to  determine  whether  a 
person  may  be  brought  under  the  influence  of  chloro- 
form during  natural  sleep  without  awakening  him  ;  in 
the  vast  majority  of  cases  it  has  been  found  impossible 
of  accomplishment.  There  are,  however,  a  few  cases  in 
which  it  has  been  done  as  an  experiment  by  medical 
men  experienced  in  its  administration ;  that  it  could 
be  accomplished  by  one  not  so  experienced  is  hardly 
credible. 

Not  unfrequently  charges  of  rape  while  under  the  in- 
fluence of  chloroform  have  been  made  against  dentists ; 
and  in  some  instances  conviction  has  followed  such 
charges.  While  a  dentist  who  would  administer  such 


DEFLORATION  AND  EAPE ;   SODOMY.  155 

an  anaesthetic  without  the  presence  and  assistance  of  a 
competent  medical  man  is,  perhaps,  deserving  of  some 
punishment,  such  charges  are  to  be  looked  upon  with 
considerable  suspicion ;  for  it  must  be  remembered  that 
not  uufrequently  women  while  under  the  influence  of 
chloroform  experience  erotic  dreams  which  have  such  a 
semblance  of  reality  that  they  are  with  difficulty  per- 
suaded of  their  non-reality  when  consciousness  has  been 
restored. 

It  should  be  a  universal  law  of  practice  with  all  medi- 
cal men  never  to  administer  any  anaesthetic  except  in 
the  presence  and  with  the  assistance  of  another  compe- 
tent medical  man  if  possible ;  or  at  least,  never  without 
the  presence  of  some  other  reliable  witness. 

An  examination  of  the  accused  may  often  furnish 
important  evidence  in  a  case  of  alleged  rape.  The  sub- 
ject of  venereal  disease  has  already  been  sufficiently 
considered.  Scratches,  especially  on  the  face,  hands, 
and  penis,  tears  of  the  clothes,  and  spots  of  blood,  semen, 
or  dirt,  should  all  be  noted.  Sometimes  a  laceration  of 
the  frcenum  prceputii  will  be  found,  especially  if  the 
accused  is  not  accustomed  to  sexual  intercourse. 

Coming  now  to.  the  stains  on  the  woman's  linen,  — 
they  are  usually  of  two  sorts,  one  pale  and  the  other 
colored.  The  colored  stains  are  usually  on  the  back 
part  of  the  chemise,  and  consist  principally  of  blood. 
There  are  two  sorts :  one  of  a  deep  red,  rich  in  coloring 
matter  equally  diffused  over  the  stain ;  and  the  second 
sort  of  a  much  lighter  red,  or  rather,  reddish-yellow 
color  at  the  centre  of  the  stain,  and  their  margins  hav- 
ing a  denned  reddish  line.  The  former  of  these  stains 
arises  from  pure  blood  ;  the  latter  from  a  sero-sanguino- 


156  MEDICAL  JURISPRUDENCE. 

lent  discharge,  becoming  gradually  less  and  less  red. 
The  subject  of  blood  stains  and  their  microscopical  ex- 
amination will  be  more  fully  considered  in  another 
place. 

Besides  the  reddish  stains  arising  from  blood  above- 
described,  there  may  be  found  broad  diffused  yellow- 
ish ones  caused  by  urine ;  those  of  a  yellow  or  green- 
ish-yellow color  due  to  feculent  matter;  light-yellow, 
diffused  and  stiffened  patches  from  muco-purulent  or 
mucous  discharges,  etc.  Seminal  stains  found  on  the 
linen  after  coition  are  usually  situated  in  front,  at  a 
point  corresponding  with  the  vulva,  although  they  are 
occasionally  found  behind. 

In  the  examination  of  a  woman  alleged  to  have  been 
violated,  the  pubic  hairs  should  be  carefully  examined 
for  spermatozoa,  which  adhere  very  closely  to  them.  In 
general  appearance  a  seminal  staiir  is  colorless  and  stiff ; 
by  transmitted  light  it  is  of  a  somewhat  grayish-brown 
tinge ;  when  warmed  it  becomes  of  a  pale-yellow  tint, 
which  is  quite  characteristic,  and  happens  with  hardly 
any  other  discharge,  healthy  or  morbid.  When  warmed 
or  moistened  with  warm  water,  the  characteristic  odor 
of  seminal  fluid  is  evolved.  If  a  small  portion  of  the 
stained  fabric  be  digested  in  a  watch-glass  with  a  few 
drops  of  water  for  about  ten  minutes,  and  the  water 
carefully  squeezed  out  from  the  fabric,  and  to  the  solu- 
tion a  drop  of  nitric  acid  be  added,  the  glass  being 
placed  in  a. good  light  on  a  piece  of  white  paper,  if  the 
stain  is  seminal  there  will  be  no  precipitate,  but  the 
liquid  will  turn  to  a  yellow  color.  In  pure  seminal 
stains  the  guaiacum  test  gives  no  blue  reaction.  Where 
the  garment  upon  which  the  stains  occur  is  dirty  or 


DEFLORATION  AND   RAPE;   SODOMY.  157 

colored,  the  above  tests  are  of  no  value ;  and,  as  a  gene- 
ral rule,  the  detection  of  the  characteristic  spermatozoa 
by  microscopic  examination  is  the  only  test  which  in 
practice  ought  to  be  relied  upon;  and  nothing  should 
be  admitted  to  be  a  seminal  stain  unless  complete  sper- 
matozoa are  found. 

Human  spermatozoa  have  a  flattened,  almost  oval 
head,  with  a  long,  slender,  filamentous  tail ;  the  entire 
length  varying  from  -^-^  to  g-^-g-  of  an  inch,  —  although 
some  may  be  found  that  do  not  exceed  yg^-g-  of  an  inch 
in  length.  The  tail  is  usually  five  or  six  times  as 
long  as  the  head,  which  is  about  -g-gVo"  °^  an  ^ncn  *n 
diameter.  The  shape  of  spermatozoa  varies  in  different 
animals.  Human  spermatozoa  are  quite  tenacious  of 
life,  and  there  are  recorded  instances  in  which  active 
spermatozoa  have  been  found  in  the  vaginal  mucus 
several  days  after  intercourse.  There  is  one  case  on 
record  in  which  they  were  found  alive  fourteen  days 
after  the  rape.  They  have  a  remarkable  power  of  resist- 
ing putrefaction,  and  even  after  they  are  dead  and  the 
stain  has  become  dry,  they  may  by  the  aid  of  a  micro- 
scope be  easily  distinguished  by  their  characteristic 
shape  even  months  after  their  emission. 

Microscopical  literature  abounds  with  descriptions  of 
the  technique  of  their  examination.  Without  entering 
into  this  subject  in  detail,  it  may  be  stated  that  the  ex- 
amination should  be  made  with  the  power  of  300  or  400 
diameters,  and  that  in  preparing  material  for  examina- 
tion the  stained  portion  of  the  fabric  should  be  cut  out 
with  as  little  handling  as  possible,  placed  in  a  clean 
watch-glass  and  moistened  with  three  or  four  drops  of 
cold  distilled  water.  After  having  allowed  it  to  soak 


158  MEDICAL  JURISPRUDENCE. 

for  about  ten  minutes,  moving  the  fabric  about  gently 
with  a  glass  rod,  the  water  may  be  squeezed  out  with  the 
end  of  the  rod  and  specimens  of  the  liquid  and  deposits 
placed  on  a  glass  slide,  covered  with  a  cover-glass  and 
examined.  If  no  spermatozoa  are  at  first  found,  the 
fabric  may  be  carefully  unravelled  and  different  por- 
tions subjected  separately  to  examination.  An  aqueous 
solution  of  methyl  blue  or  fuchsin  will  often  serve  to 
differentiate  the  spermatozoa. 

It  should  be  remembered,  however,  that  spermatozoa 
do  not  always  occur  in  the  seminal  fluid,  especially  in 
the  prostatic  fluid  which  has  been  ejaculated  after  one 
or  more  prior  emissions ;  and  also  that  in  some  cases  of 
disease  no  spermatozoa  are  found.  Their  absence  also 
is  not  unusual  in  the  seminal  fluid  of  the  old  and  the 
feeble,  so  that  the  failure  to  find  spermatozoa  in  the 
alleged  seminal  stain  will  not  invalidate  a  charge  of 
rape  ;  and  their  discovery,  upon  the  other  hand,  is  at  the 
most,  only  evidence  of  the  fact  of  previous  sexual  inter- 
course without  determining  whether  it  was  voluntary  or 
involuntary.  The  expert  microscopist  will  not  be  likely 
to  confound  human  spermatozoa  with  anything  else,- 
There  are,  however,  certain  fungi  which  are  said  to  re- 
semble spermatozoa ;  their  tails,  however,  are  clumsier, 
and  they  refract  light  differently. 

An  animalcule  called  trichomonas  vaginalis  is  some- 
times found  in  the  vaginal  mucus  of  females  not  remark- 
able for  their  cleanliness,  which  has  been  supposed  to 
bear  some  resemblance  to  seminal  animalcule.  The 
heads  of  the  trichomonads,  however,  are  very  much 
larger  than  those  of  spermatozoa,  and  are,  moreover,  fur- 
nished with  several  ciliae,  while  the  spermatozoa  have 


DEFLORATION  AND  RAPE;   SODOMY.  159 

none.  Internally,  moreover,  the  trichomonads  are  granu- 
lar, which  is  not  the  case  with  spermatozoa. 

The  third  element  of  the  crime  of  rape,  namely,  that 
the  intercourse  was  by  force  and  against  the  will  of  the 
female,  has  already  been  somewhat  considered  in  what 
has  preceded.  As  a  rule,  independent  of  the  marks  of 
violence  on  the  person  of  the  woman,  evidences  of  a 
struggle,  etc.,  this  element  of  the  crime  must  be  estab- 
lished by  the  ordinary  rules  of  evidence  with  which  the 
medical  jurist  has  nothing  to  do.  This  topic  may,  with 
propriety,  be  left  to  the  officers  charged  with  the  admin- 
istration of  the  law. 

Sodomy.  —  Sodomy,  sometimes  called  "  buggery," 
sometimes  "  the  offence  against  nature,"  and  sometimes 
"  the  horrible  crime  not  fit  to  be  named  among  Chris- 
tians," consists  of  a  carnal  copulation  by  two  human 
beings  with  each  other  against  nature,  or  by  a  human 
being  with  a  beast.  Unlike  rape,  sodomy  may  be  com- 
mitted between  two  persons  both  of  whom  consent ;  it 
may  be  committed  between  husband  and  wife,  between 
two  men,  or  a  boy  and  a  man.  By  "  sodomy  "  is  ordi- 
narily understood  the  offence  between  man  and  man,  or 
between  man  and  woman ;  where  the  victim  is  a  boy, 
sodomy  is  usually  termed  "  pcederastia." 

By  "  bestiality  "  is  meant  intercourse  by  the  human 
kind,  male  or  female,  with  an  animal,  male  or  female, 
other  than  the  human  kind.  The  term  "  buggery  "  in- 
cludes unnatural  intercourse  both  with  mankind  and 
with  animals. 

According  to  Lord  Coke,  emission  is  a  necessary  ele- 
ment of  the  crime  of  sodomy,  but  at  present  time  by 
statute  both  in  England  and  in  this  country,  penetration 


160  MEDICAL  JURISPRUDENCE. 

is  sufficient,  as  in  rape,  without  proof  of  emission.  A 
penetration  of  the  mouth  is  not  sodomy,  neither  is  an 
unnatural  connection  with  a  fowl,  —  a  fowl  not  coming 
under  the  term  "  beast." 

As  to  the  appearance  of,  and  the  effects  produced 
upon  the  criminals,  it  is  said  that  if  the  crime  has  been 
habitual  and  frequent,  there  will  be  the  usual  evidence 
of  sexual  excess,  and  premature  decay  of  strength,  the 
apparent  age  of  the  person  far  exceeding  the  real,  etc. 
The  penis  is  said  to  be  commonly  found  elongated ;  the 
glans  more  than  usually  bulbous  and  conical,  and  the 
urethra  twisted.  The  natural  fold  about  the  anus  of 
the  passive  criminal,  and  those  that  radiate  towards  the 
anus,  become  rapidly  obliterated  by  repetitions  of  the 
crime,  giving  the  skin  of  the  part  a  smooth  appearance ; 
moreover,  a  peculiar  funnel-like  or  trumpet-shaped  de- 
pression or  hollow  of  the  nates  is  usually  observed. 
This  appearance,  however,  it  should  be  observed,  may 
be  produced  by  other  than  criminal  practices,  such  as 
the  necessity  in  some  people  of  pushing  back  piles  or 
slight  protrusions  of  the  rectum  forced  out  during  defe- 
cation. Where  the  crime  is  committed  on  one  unac- 
customed thereto,  the  passive  agent,  if  examined  soon 
after,  will  exhibit  a  certain  amount  of  bruising  and  in- 
flammation, with  a  slight  laceration  of  the  sphincter. 
There  may  be  congestion  and  abrasion  of  the  anal  mu- 
cous membrane  without  injury  to  the  sphincter;  in 
some  cases  seminal  stains  will  constitute  important 
evidence. 

Where  that  form  of  sodomy  known  as  bestiality  has 
been  committed,  the  principal  medical  evidence  will 
consist  in  the  finding  of  spermatozoa  on  the  person  or 


DEFLORATION  AND  RAPE;   SODOMY.  161 

clothes,  or  on  the  hairs  of  the  animal ;  or  in  identifying 
the  hairs  of  such  aiiiinal  on  the  accused,  both  of  which 
may  be  done  by  the  aid  of  the  microscope.  If  the  hairs 
of  the  animal  be  found  adhering  to  stains  of  blood, 
mucus,  or  semen,  on  the  underclothing  of  the  accused, 
this  fact  will  have  considerable  weight. 


11 


CHAPTER  XIIL 

IMPOTENCE  AND   STERILITY. 

QUESTIONS  respecting  impotence  and  sterility  more 
frequently  arise  upon  bills  for  a  divorce;  although 
impotence  may  sometimes  be  alleged  as  a  defence  in 
rape,  or  may  be  given  in  evidence  upon  the  issue  of 
bastardy  or  illegitimacy  of  a  child,  and  perhaps  in  other 
cases. 

Marriage  between  two  persons  of  the  same  sex  is  void, 
because  none  of  the  ends  of  matrimony  can  be  accom- 
plished thereby.  The  subject  of  doubtful  sex  will,  how- 
ever, be  considered  in  another  chapter. 

In  order  that  a  marriage  may  be  valid,  the  parties, 
both  of  opposite  sexes,  should  have  their  sexual  organ- 
ization and  capabilities  essentially  complete;  impo- 
tence, therefore,  is  everywhere  considered  sufficient 
ground  for  decreeing  the  nullity  of  a  marriage.  In 
countries  governed  by  the  common  law,  a  marriage  will 
be  good  if  there  is  an  adequate  power  of  mere  copula- 
tion, though  in  the  ordinary  case  pregnancy  cannot  be 
made  to  follow ;  but  the  copula  must  be  adequate  as 
such  or  the  marriage  will  be  invalid ;  yet  if  pregnancy 
is  actually  produced  by  an  otherwise  inadequate  copula, 
this,  according  to  Mr.  Bishop,  will  render  the  marriage 
unimpeachable.  The  doctrine  settled  by  the  weight  of 


IMPOTENCE  AND  STERILITY.  163 

authority  is  believed  to  be  that  the  ground  of  interfer- 
ence by  the  court  in  cases  of  impotency  is  the  practical 
impossibility  of  connection.  It  is  not  necessary,  as  it 
seems,  that  there  be  a  structural  defect  rendering  copu- 
lation impossible  ;  if  it  is  impracticable  that  will  be  re- 
garded as  sufficient.  It  has  been  held  in  several  cases 
that,  where  there  is  a  practical  impossibility  of  copula- 
tion, which,  however,  the  evidence  disclosed  might  be 
removed  by  surgical  treatment  which  would  not  en- 
danger the  life  of  the  respondent,  if  the  respondent  re- 
fuses to  submit  to  such  treatment,  a  decree  dissolving 
the  marriage  will  be  granted.  "Where,  however,  there  is 
capacity  of  body,  but  the  respondent  merely  refuses  to 
submit  to  the  embraces  of  the  complainant,  this  consti- 
tutes no  ground  for  a  decree.  The  defect,  then,  must 
either  be  incurable  or,  according  to  the  better  opinion, 
it  must  be  such  as  practically  prevents  sexual  inter- 
course ;  and  if  curable,  the  respondent  must  have  posi- 
tively refused  to  submit  to  treatment  for  that  purpose. 
Where,  however,  the  medical  evidence  shows  that  the 
malformation  might  possibly  at  great  risk  of  life  and  by 
an  operation  of  doubtful  success,  be  removed,  the  peti- 
tioner is  not  bound  to  call  upon  the  respondent  to  sub- 
mit to  such  a  risk,  and  this  state  of  facts  is  deemed 
equivalent  to  a  permanent  and  incurable  malformation. 

It  appears  to  be  settled  that  mere  incapacity  of  con- 
ception where  there  is  capacity  for  copulation  is  not 
sufficient  ground  whereon  to  found  a  decree  of  nullity. 

The  causes  of  impotence  in  the  male  are  chiefly  the 
following :  — 

1.  Extreme  youth,  before  the  arrival  of  puberty,  is  of 
course  accompanied  by  impotence.  The  ages  of  fourteen 


164  MEDICAL  JURISPRUDENCE. 

in  the  male  and  twelve  in  the  female  are  recognized  by 
the  common  law  as  the  earliest  ages  at  which  a  valid 
marriage  can  be  contracted.  These  ages  have  been 
changed  somewhat  by  statute  in  different  States.  Pu- 
berty is  sometimes  anticipated,  there  being  recorded  in- 
stances of  puberty  in  boys  as  early  as  four  or  five  years, 
and  in  girls  of  the  presence  of  menstruation  almost  from 
birth.  On  the  other  hand,  puberty  is  often  deferred 
until  quite  an  advanced  age.  Mere  old  age  cannot  be 
regarded  as  involving  sexual  incapacity,  although  the 
sexual  powers  are  usually  very  much  diminished  by 
old  age. 

This  general  subject,  however,  will  more  properly  be 
considered  in  the  chapter  on  LEGITIMACY  AND  PATER- 
NITY. 

2.  The  impotence  which  more  frequently  is  a  ground 
for  a  decree  of  nullity  is  that  which  arises  from  con- 
genital or  other  defects.  The  subject  of  hermaphrodism 
will  be  considered  in  another  connection ;  suffice  it  to 
say  here  that  if  it  exists  to  such  an  extent  as  to  defeat 
the  ends  of  marriage,  it  is  ground  for  a  decree.  The  en- 
tire absence  of  the  penis,  whether  congenital  or  the  result 
of  disease  or  accident,  is  clearly  ground  for  a  decree. 
When  there  is  any  intromittent  organ,  however  small, 
the  medical  jurist  should  be  very  cautious  in  pronounc- 
ing a  man  impotent.  It  should  be  remembered  that 
impregnation  may  occur  with  an  unbroken  hymen  and 
where  the  male  organ  is  so  short  as  only  to  be  capable 
of  depositing  semen  within  the  vulva.  It  may,  per- 
haps, be  stated  that  a  charge  of  impotence  on  account 
of  the  abnormal  condition  of  the  male  organ  will  not  be 
regarded  as  sustained  short  of  evidence  of  the  absolute 


IMPOTENCE  AND   STERILITY.  165 

and  complete  loss  of  the  penis,  or  of  its  most  extraor- 
dinary development.  Each  case,  however,  as  it  seems, 
should  be  decided  on  its  own  facts  in  accordance  with 
the  general  principles  above  stated. 

An  extreme  degree  of  hypospadias  or  epispadias  may 
in  some  instances  amount  to  incapacity.  Some  other 
malformations,  or  complaints,  such  as  the  abnormal 
direction  of  the  penis,  its  attachment  to  the  abdomen, 
phymosis,  paraphymosis,  etc.,  are  sometimes  alleged  as 
causes  of  impotency.  As  in  most  cases  they  may  be 
corrected  by  a  slight  surgical  operation,  there  would 
seem  not  to  be  ground  for  divorce  in  such  cases. 

No  reported  case  has  come  to  our  notice  deciding  the 
question  whether  the  absence  of  both  testicles,  the 
power  of  copulation  remaining,  however,  is  a  ground  for 
a  divorce.  The  absence  of  one  testicle,  or  the  non- 
descent  of  the  testicles,  is  clearly  consistent  with  the 
ability  to  procreate,  and  there  would  seem  to  be  no 
doubt  that  in  such  case  there  is  no  ground  for  a  divorce. 
This  subject  will,  however,  be  considered  further  in  the 
chapter  on  LEGITIMACY  AND  PATEKNITY. 

3.  Impotency  may  be  caused  by  disease  of  the  male 
sexual  organs,  such  as  syphilis,  cancer,  or  tuberculosis. 
Masturbation  may  be  a  cause  both  of  sterility  and  im- 
potency. 

Injuries  to  the  head  and  spine,  and  certain  general 
diseases,  may  in  some  instances  produce  impotency. 

Complete  sexual  incapacity  or  impotence  in  the 
female  is  very  rare.  The  most  common  congenital 
cause,  perhaps,  of  such  condition  is  the  entire,  or  almost 
entire,  absence  of  the  vagina.  In  one  reported  case  the 
vagina  was  contracted  in  depth,  admitting  the  penis  to 


166  MEDICAL  JURISPRUDENCE. 

perhaps  less  than  half  the  usual  extent,  and  ending  in  a 
cul-de-sac,  without  communicating  with  any  of  the  in- 
ternal organs ;  there  appeared  to  be  an  entire  absence 
of  the  uterus.  The  defect  being  deemed  incurable  and 
not  admitting  of  complete  copulation,  the  marriage  was 
set  aside. 

In  some  cases  an  attempt  has  been  made  to  form  an 
artificial  vagina  by  operation,  where  none  exists,  but 
such  attempts  can  hardly  be  said  to  be  successful,  and 
doubtless  the  woman  could  not  be  called  upon  to  submit 
to  such  an  operation.  Mere  occlusion  of  the  vagina  by 
adhesion  of  the  labia,  or  by  an  imperforate  hymen  may, 
however,  in  most  instances  be  remedied  by  a  slight 
operation ;  aud  if  the  woman  should  decline  this  opera- 
tion, according  to  the  rules  already  stated,  a  decree 
should  be  granted.  A  decree  has  been  granted  in 
several  instances  where  there  has  been  so  very  great  a 
degree  of  sensibility  of  the  vagina,  accompanied  in  some 
instances  by  spasms,  or  perhaps  by  hysteria,  as  to 
amount  practically  to  an  impossibility  of  having  sexual 
connection.  Upon  the  principles  already  stated,  even 
though  such  defects  might  be  remedied  by  surgical  or 
medical  treatment,  if  the  respondent  should  refuse  to 
submit  to  such  treatment  a  decree  should  be  granted. 

This  subject  and  the  kindred  subject  of  sterility  will 
be  further  considered  in  the  chapter  on  LEGITIMACY  AND 
PATERNITY.  See,  also,  the  next  chapter. 


CHAPTER  XIV. 

SEX,  HERMAPHRODISM,   AND   MONSTROSITIES. 

Sex.  —  The  question  of  the  sex  of  an  individual  is 
not  unfrequently  one  of  considerable  importance,  both 
as  a  matter  of  identification  of  the  individual  (which 
will  be  more  fully  considered  in  a  subsequent  chapter), 
and  also  in  determining  the  rights  of  property  depend- 
ing upon  courtesy,  descent,  etc. 

If  a  body  or  considerable  portions  of  a  body  are  found, 
there  will  be  little  difficulty  in  determining  the  sex  if 
the  genital  organs  are  present,  except  in  rare  instances 
of  doubtful  sex. 

Besides  the  general  contour  of  the  shoulders  and  hips 
noticed  below,  the  breasts  of  the  female  are,  as  a  rule, 
more  developed  than  those  of  the  male.  The  pubic 
hairs  of  the  male  extend  higher  towards  the  umbilicus 
than  those  of  the  female ;  the  distance  between  the 
navel  and  the  pubes  in  the  male  is  shorter  than  between 
the  navel  and  the  scrdbiculus  cordis ;  in  females  the 
reverse  is  the  case.  Males  have  more  hair  on  the  body, 
but  less  and  shorter  hair  on  the  head.  In  the  male  the 
pomum  Adami  and  the  larynx  are  larger  than  in  the 
female.  The  average  male  head  is  larger  and  the  brain 
heavier  than  in  the  case  of  females. 

"Where  a  body  is  found  in  a  state  of  decomposition,  it 
should  be  remembered  that  the  uterus  has  remarkable 


168  MEDICAL  JURISPRUDENCE. 

powers  of  resisting  putrefaction,  and  the  sex  may  often 
be  determined  from  it  when  recognition  from  other 
organs  has  been  rendered  impossible  by  decomposition. 

It  should  be  remembered  that  until  the  age  of  puberty 
there  is  little  difference  in  the  general  characteristics 
of  isolated  bones  or  complete  skeletons  of  the  two  sexes, 
although  generally  male  children  are  somewhat  taller 
and  heavier  than  females  of  the  same  age. 

The  general  characteristics  of  skeletons  or  of  the  indi- 
vidual bones  of  adults,  are  as  follows :  — 

In  the  male,  the  shoulders  are  broader  than  the  hips ; 
the  bones  usually  present  rougher  and  more  prominent 
markings  at  the  points  of  attachment  of  the  muscles 
than  those  of  the  female,  and  the  male  skeleton  gen- 
erally exceeds  that  of  the  female  both  in  height  and 
weight. 

In  the  female,  the  hips  are  broader,  thighs  shorter 
and  larger,  and  the  tuberosities  of  the  ischia  and  the 
acetabula  farther  apart.  The  female  skull  is  said  to  be 
smaller,  more  ovoid,  more  bulging  at  the  sides,  and  lar- 
ger behind  the  foramen  magnum  than  that  of  the  male. 
The  face  more  oval,  frontal  sinuses  less  strongly  marked, 
nostrils  more  delicate,  jaws  and  teeth  smaller,  and  the 
chin  less  prominent.  The  chest  of  the  female  is  said  to 
be  deeper  than  that  of  the  male ;  the  sternum  shorter 
and  more  convex ;  the  ensiform  cartilage  thinner  and 
ossified  later  in  life;  ribs  smaller  and  the  cartilages 
longer.  The  vertebral  column  is  longer  and  the  bodies 
of  the  vertebrae  deeper  in  the  female  than  in  the  male. 
The  bones  of  both  upper  and  lower  extremities  are 
generally  smaller  and  lighter  in  the  woman  than  in  the 
man. 


SEX,  HERMAPHRODISM,  ETC.  169 

In  many  instances,  however,  it  would  seem  to  be 
impossible  to  determine  the  sex  of  an  individual  from 
an  inspection  of  the  skeleton  without  an  examination 
of  the  pelvis.  The  male  pelvis  presents  a  narrow  but 
deep  excavation  with  smaller  apertures ;  its  bones  are 
thick,  its  muscular  impressions  well  marked  and  its 
angles  abrupt  and  prominent. 

The  female  pelvis  is  not  so  deep  as  that  of  the  male 
but  considerably  exceeds  it  in  its  transverse  and  antero- 
posterior  dimensions.  The  cavity  is  more  capacious, 
its  apertures  larger,  its  walls  less  massive  and  rough, 
while  its  general  contour  is  less  angular  and  abrupt. 
The  alee  of  the  ossa  innominata  spread  further  outwards, 
the  anterior  superior  spinous  processes  and  the  tube- 
rosities  of  the  ischia  and  the  acetabula  being  removed 
to  a  greater  distance  from  the  median  line,  whence 
arises  the  prominence  of  the  hips  in  women.  The 
sacrum  is  wider  and  less  curved,  and  the  sacro-verte- 
bral  angle  less  prominent  than  in  the  male.  The  ob- 
turator foramen  is  somewhat  triangular  in  form  and 
smaller  in  size  than  the  male ;  the  ischiatic  spines  pro- 
ject less  into  the  cavity  of  the  pelvis  ;  the  coccyx  is 
more  movable  and  the  symphysis  pubis  less  deep  ;  the 
upper  aperture  is  more  nearly  circular,  its  margin 
smoother  and  more  rounded,  the  pubic  arch  is  wider 
and  more  curved,  and  the  rami  are  everted  so  as  to 
present  shelving  surfaces  rather  than  angular  edges  to 
any  object  descending  through  the  perineal  strait. 
The  angle  beneath  the  arch  of  the  pubis  is  more  obtuse 
than  in  the  male.  In  the  male  this  angle  varies  from 
75  to  80  degrees,  while  in  woman  it  varies  from  90  to 
100  degrees. 


170 


MEDICAL  JURISPRUDENCE. 


The  above  peculiarities  of  form  are  such  as  to  permit 
the  expansion  of  the  uterus  and  the  passage  of  the  child 
in  parturition. 

The  dimensions  of  male  and  female  pelves  according 
to  Dr.  Tidy  are  as  follows :  — 


Hale. 

Female. 

Is 

£  3 

Is    |  § 

13        S3 

Between  the  antero-superior  spinous  processes 
of  the  ilia    

7  8 

8  3 
4  6 
4  5 
4  0 
4  0 
5  0 
5  0 
3  0 
3  3 

8  6  to  10  0 

94      11   1 
50        56 
45        55 
40        44 
47        48 
52         54 
47        48 
40         45 
44        50 

Between  the  middle  points  of  the  cristse  of  the 

The  transverse 
oblique 
antero-posterior 
transverse 
oblique 
antero-posterior 
transverse 
antero-posterior 

diameter  of  the  abdom- 
inal strait  of  the  true 
pelvis 

diameter  of  the  cavity 
of  the  true  pelvis 

diameter  of  the  perineal 
strait  of  the  true  pelvis 

The  diameters  of  the  female  pelvis  are,  according  to 
Dr.  Lusk,  as  follows  :  — 

The  diameters  of  Superior  Strait  or  Brim :  — 

Antero-Posterior  or  (anatomical)  conjugate,  4J  inches. 

The  obstetrical  conjugate  diameter,  measured  about  £  of 
an  inch  below  the  upper  border  of  the  symphysis,  is  only 
4  inches. 

The  transverse  or  bis-iliac  diameter  of  the  brim,  5^  inches. 

Oblique  diameter  from  the  ilio-pectineal  eminence  to  the 
opposite  sacro-iliac  articulation,  5  inches. 

The  circumference  of  the  brim  is  very  nearly  16  inches. 


SEX,  HERMAPHRODISM,  ETC.  171 

The  diameters  of  the  Inferior  Strait   or   outlet   of  the 

pelvis :  — 

Antero-Posterior,  3f  inches.  When  the  coccyx  is  pushed 
back  it  may  extend  to  4£  inches. 

Transverse  diameter,  4J  inches. 

Owing  to  the  elasticity  of  the  sciatic  ligaments,  the  oblique 
diameters  are  not  of  obstetrical  importance. 

The  circumference  of  the  Inferior  Strait  is  13£  inches. 

Below  the  brim  the  dimensions  are  increased  considerably 
by  the  concavity  of  the  sacrum ;  thus  a  plane  passing 
through  the  lower  portion  of  the  symphysis  pubis  and  across 
the  upper  margins  of  the  acetabula  to  the  junction  of  the 
second  and  third  sacral  vertebrae,  gains  f  inches,  in  the  con- 
jugate, while  the  transverse  diameter  is  barely  ^  inch  less 
than  the  transverse  diameter  of  the  brim.  The  narrowing 
of  the  outlet  is  most  marked  in  a  plane  drawn  so  as  to 
intersect  the  spines  of  the  ischia  and  the  extremity  of 
the  sacrum ;  at  this  level  the  transverse  diameter  between 
the  spines  is  but  4  inches,  and  the  antero-posterior  diameter 
4£  inches. 

Hermaphrodism.  —  The  determination  of  sex  in  cases 
where  the  organs  of  generation  are  malformed  is  some- 
times a  matter  of  some  difficulty,  and  occasionally 
nothing  short  of  actual  dissection  after  death  has  dis- 
covered the  true  sex  of  the  individual.  A  full  discus- 
sion of  this  subject  is  beyond  the  scope  of  this  manual. 
The  malformation  is  seldom  confined  to  the  genitals 
alone,  but  often  extends  to  the  conformation  of  the 
body  generally,  and  even  to  the  distinctive  mental  facul- 
ties, while  the  sexual  desires  are  either  wanting  alto- 
gether or  sometimes  point  in  the  wrong  direction.  In 


172  MEDICAL  JURISPRUDENCE. 

this  connection  only  the  more  important  facts  will  be 
stated. 

Hermaphrodism  may  be  divided  into  false  and  true. 
In  the  first  species,  the  genital  organs  and  general 
sexual  conformation  of  one  sex  approach  from  imperfect 
or  abnormal  development,  those  of  the  opposite  sex. 
In  the  second  or  true  hermaphrodism,  there  actually 
co-exists  upon  the  body  of  the  same  individual  more 
or  fewer  of  the  genital  organs  and  distinctive  sexual 
characters,  both  of  the  male  and  female.  Strictly, 
perhaps,  hermaphrodism  should  be  defined  as  the 
co-existence  in  a  single  individual  of  completely 
developed  ovaries  and  testicles,  or  one  at  least  of  each 
gland,  the  genital  gland  being  the  only  reliable  test 
of  sex.  But  in  this  strict  sense  it  is  probable  that 
no  true  human  hermaphrodite  has  ever  existed,  or 
at  least  such  a  one  as  has  been  able  to  perform  the 
functions  of  either  sex  independently  and  to  effect 
self-impregnation. 

With  proper  care  and  attention  it  is  always  easy, 
says  Dr.  Ogston,  to  discover  the  true  sex  in  the  dif- 
ferent varieties  of  false  hermaphrodism.  It  is  chiefly 
in  regard  to  the  so-called  true  hermaphrodite  that 
mistakes  have  arisen,  even  in  the  hands  of  competent 
observers. 

The  table  of  Sir  James  Simpson  as  altered  by  Dr. 
Ogston,  is  here  given  in  order  to  facilitate  the  under- 
standing of  this  subject :  — 


SEX,  HERMAPHRODISM,  ETC. 


173 


I.  Spurious.  • 


II.  True. 


1.  In  the  female, 

Androgynae. 

2.  In   the   male, 

Gynandri. 


f  1.  Lateral. 


2.  Transverse. 


Vertical  or 
double. 


(1.)  From  enlarged  clitoris. 

(2.)  From  prolapsus  uteri. 

(1.)  From  extroversio  vesicae. 

(2.)  From  adhesion  of  the  penis  to 
the  scrotum. 

(3.)  From  hypospadia. 

(1.)  Testis  on  the  right,  and  ovary 
on  the  left  side. 

(2.)  Testis  on  the  left,  and  ovary 
on  the  right  side. 

(1.)  External  sexual  organs  fe- 
male, internal  male. 

(2.)  External  sexual  organs  male, 

internal  female. 

( (1.)  Ovaries,  imperfect  uterus,  ve- 
siculae  seminales,  and  rudi- 
mentary vasa  deferentia. 

(2.)  Testes,  vasa  deferentia,  vesi- 
culae  seminales,  and  imper- 
fect uterus  and  its  appen- 
dages. 

(3.)  Ovaries,  and  testes  co-existing 
on  one  or  both  sides. 


1.  In  most  cases  where  females  have  been  mistaken 
for  males,  the  enlarged  clitoris  is  the  prominent  feature  ; 
a  consideration,  however,  of  the  anatomical  distinctions 
between  the  clitoris  and  the  penis,  which  may  be  found 
in  any  work  on  anatomy,  is  sufficient  to   distinguish 
the  two  organs. 

The  prolapsed  uterus  could  only  be  mistaken  for  a 
penis  by  one  ignorant  of  the  anatomical  distinctions 
between  the  two  organs. 

2.  Cases  of  spurious  hermaphrodism  in  the  male  aris- 
ing from  the  obtrusion  of  the  bladder,  the  adhesion  of 
the  inferior  surface  of  the  penis  to  the  scrotum,  and 
from  hypospadiac  cleft  of  the  penis,  as  a  rule  present 
no  difficulty  to  the  careful  examiner ;  where,  however, 
the  gland  is  imperforate,  and  the  penis  itself  diminutive 
in  size,  —  resembling  an  enlarged  clitoris,  with  the  ure- 


174  MEDICAL  JURISPRUDENCE. 

thra  opening  in  a  fissure  of  some  length  further  back 
towards  the  perinseum,  —  there  may  be  more  difficulty. 
In  such  cases  the  scrotum  is  usually  found  split  into 
two  lateral  halves,  resembling  the  labia  major  a ;  in  such 
a  case  should  the  testes  not  have  descended  from  the 
abdomen  the  question  would  be  even  more  difficult. 
There  are  recorded  instances  of  this  sort  where  such  a 
hypospadian  has  married  and  cohabited  with  a  husband 
for  a  long  term  of  years  without  the  true  sex  having 
been  discovered.  In  such  cases  the  true  criterion  of  sex 
is,  as  we  have  already  stated,  the  presence  of  the  distinc- 
tive genital  glands,  the  testicle  or  the  ovary.  The  deter- 
mination whether  a  body  in  what  appears  to  be  a  labium 
is  a  testicle  or  not  is,  however,  not  always  easy ;  it  may 
be  impossible  of  determination  without  dissection. 

It  should  be  remembered  in  this  connection,  that  a 
very  feminine  appearance  may  result  from  non-descent 
of  the  testes  or  even  of  a  testis,  especially  if  atrophy  of 
the  organ  has  taken  place. 

The  so-called  true  hermaphrodisui  may  be  considered 
under  the  three  divisions  given  in  the  table. 

1.  A  peculiarity  of  the  sexual  organs  in  cases  of 
lateral  hermaphrodisin  is  that  in  the  same  individual 
there  is  found  on  one  side  of  the  median  line  what  is 
or  resembles  a  testicle  and  its  appendages,  and  on  the 
other  side  an  ovary  and  its  appendages.  In  such  cases 
the  ovary  is  more  frequently  found  on  the  left  side.  In 
these  instances,  also,  along  with  the  testicle  on  one  side 
and  the  ovary  on  the  other,  there  generally  coexists  a 
more  or  less  perfectly  formed  uterus,  while  the  external 
parts  of  generation  and  of  the  body  generally  differ  in 
their  sexual  characters,  in  some  instances  beiug  female, 


SEX,  HERMAPHRODISM,  ETC.  175 

in  others  male,  and  in  others  of  an  indeterminate  type. 
In  some  cases  of  lateral  hermaphrodism  spermatozoa 
have  been  found  in  the  seminal  fluid,  while  in  others  a 
periodic  menstrual  discharge  has  been  recorded,  —  such 
conditions  indicating  the  prevailing  sex.  Dr.  Tidy  re- 
cords a  case  where  were  not  only  spermatozoa  dis- 
covered in  the  secretion  of  the  testicle,  but  regular 
menstruation  was  said  to  have  occurred  from  the  age  of 
ten,  and  in  which  there  were  double  sexual  instincts. 

2.  In  so-called  transverse  hermaphrodism,  the  exter- 
nal organs  may  be  male  and  the  internal  female,  or  the 
reverse.     By  the  terms  external  and  internal  are  not 
meant  those  placed  superficially  or  more  deeply  in  the 
body.     Those  parts  of  the  genitals  which  are  covered 
by  the  common  integument  or  are  lined  by  the  mucous 
membrane,  and  thus  communicating  with  the  external 
air,  are  classed  as  external,  —  including  the  vagina  and 
uterus.     The  testis,  though  more  exposed  from  being 
placed  outside  the  pelvis,  is  termed  an  internal  organ. 

In  cases  of  this  sort  of  true  hermaphrodism  nothing 
short  of  dissection  after  death  can  determine  the  sex. 
The  existence  in  such  cases  of  a  body  which  might  be 
a  testicle  in  the  labium  is  considered  by  Dr.  Ogston  as 
too  slight  evidence  whereon  to  form  a  decision. 

3.  Cases  of  the  third  variety  of  hermaphrodism  can- 
not be  verified  during  life,  and  their  real  nature  can 
only  be  determined  by  dissection  after  death.     In  cer- 
tain  rare   cases,   according    to    Dr.   Tidy,   ovaries   are 
associated  with  both  male  and  female  passages ;  and  in 
other  very  rare  cases,  testicles .  are  similarly  associated ; 
while  in  a  third  class  both  ovaries  and  testicles  coexist 
in  the  same  connection.     Two  cases  are  recorded  by 


176  MEDICAL  JURISPRUDENCE. 

him  in  which  periodic  menstruation  and  a  seminal 
secretion  containing  spermatozoa  occurred. 

Sexless  Beings.  —  According  to  Dr.  Tidy,  individuals 
are  occasionally  found  presenting  precisely  opposite  char- 
acters from  those  of  hermaphrodites ;  namely,  beings 
that  have  the  essential  features  of  neither  males  nor 
females.  Several  cases  are  recorded  by  him  in  which 
the  genital  organs  are  said  to  be  entirely  wanting  in 
children  born  alive. 

The  following  conclusions  are  arrived  at  by  Dr.  Tidy  : 

1.  Given  the  presence  of  a  testicle  or  testicles,  where- 
ever  placed,  and   of  a  single  opening  communicating 
with  a  bladder  and  not  with  a  uterus,  —  especially  if 
there  be  seminal  emissions  containing  spermatozoa  and 
an  absence  of  periodic  hemorrhages,  —  the  individual 
in  question  is  to  be   accounted   as  a  male,  and   that 
independently  of  anatomical  malformations,  such  as  the 
presence  of  an  imperforate  penis,  or  its  entire  absence,  or 
the  existence  of  the  feminine  configuration  or  instincts. 

2.  Given  the  presence  of  an  ovary  or  ovaries,  espec- 
ially if  there  are  periodic  hemorrhages,  the  individual 
in  question  is  to  be  accounted  as  a  female,  and  that  in- 
dependently of  anatomical  malformations,  such  as  the 
existence  of  a  penis-like  body,  or  of  male  configuration 
and  instincts. 

3.  Given  the  presence  of  glands  that  may  be  either 
ovaries  or  testicles,  and  the  precise  nature  of  which 
there  is  difficulty  in  deciding;   or  given  the  absence 
of  both  ovaries  and  testicles,  together  with,  in  either 
case,  the   absence   both   of  seminal  emissions   and  of 
periodic  hemorrhages,  —  then  the  presence  of  a  uterus 
and  of  a  second  opening  below  and  distinct  from  the 


SEX,  HERMAPHRODISM,  ETC.  177 

opening  to  the  bladder,  should  be  sought  for.  If  a 
uterus  or  a  second  opening  of  the  nature  described  be 
found,  the  individual  is  to  be  accounted  as  a  female, 
and  that  independently  of  anatomical  malformations,  or 
of  male  configuration  and  instincts.  But  if,  on  the 
contrary,  there  be  no  uterus  and  no  second  opening 
below  and  distinct  from  the  opening  to  the  bladder, 
then  the  male  sex  is  strongly  indicated. 

4.  When  the   anatomical  conditions  are  so  equally 
balanced  that  neither  sex  seems  to  prevail,  the  exist- 
ence  of   periodic   hemorrhages   is   to   be   regarded   as 
strongly  indicative  of  the  sex  being  female  ;  while  on 
the  other  hand,  the  existence  of  emissions  are  strongly 
indicative  of  the  sex  being  male.     In  the  latter  case, 
however,  if  spermatozoa  can  be  detected  in  such  indi- 
vidual, the  proof  that  the  same  is  male  is  complete. 

5.  Sexual  inclinations,  habits  and  tastes,  and  general 
configuration  of  the  body,  should  in  all  cases  be  con- 
sidered.    If   they   support   the   conclusions   based   on 
the  principles  above  laid  down,  they  may  be  regarded 
as  valuable  confirmatory  evidence ;  but  if,  on  the  con- 
trary, they  fail  to  conform  or  even  appear  at  variance 
with  such  conclusions,  they  may  then  be  entirely  dis- 
regarded. 

Monstrosities.  —  According  to  Blackstone,  it  is  a  very 
ancient  rule  of  the  law  of  England,  that  "a  monster 
which  hath  not  the  shape  of  mankind,  but  in  any  part 
evidently  bears  the  resemblance  of  the  brute  creation, 
hath  no  inheritable  blood  and  cannot  be  heir  to  any 
land,  albeit  it  be  brought  forth  in  marriage ;  but  although 
it  hath  deformity  in  any  part  of  its  body,  yet  if  it  hath 
human  shape  it  may  be  heir." 

12 


178  MEDICAL  JURISPRUDENCE. 

In  a  case  of  this  nature,  Dr.  Tidy  well  says  that 
"  the  duty  of  the  medical  jurist  would  be  best  per- 
formed by  describing  with  the  greatest  detailed  accu- 
racy in  what  respects  the  individual  in  question  differs 
from  the  human,  leaving  the  court  to  say  whether  it 
be  without  the  shape  of  mankind  or  not." 

If  the  individual  in  question  has  the  shape  of  man- 
kind and  is  therefore  capable  of  inheriting,  the  deter- 
mination of  its  sex  may  be  important  with  respect  to 
questions  of  inheritance,  questions  of  divorce,  business, 
etc.  This  question  has,  however,  already  been  con- 
sidered. 

The  scope  of  this  manual  forbids  our  entering  into 
the  subject  of  Teratology  in  detail ;  for  full  information 
upon  this  interesting  subject,  the  student  is  referred  to 
professed  treatises  thereon. 

In  determining  whether  the  monster  has  the  shape 
of  mankind  or  not,  it  may  be  stated  that  congenital 
deformities  arising  from  a  deficiency  of  structure,  with 
arrested  or  defective  development  of  parts,  may  give 
rise  to  acardiac  monsters  (monsters  having  no  heart) ; 
acephalous  monsters  (monsters  without  a  head) ;  mon- 
sters anencephalic  (having  no  brain,  —  the  forehead, 
cranial  vault,  and  brain  being  entirely  wanting) ;  or 
monsters  with  structural  deformities  of  various  kinds, 
such  as  the  absence  of  arms,  nose,  eyes,  ears,  etc. 

Acardiac  and  acephalous  monsters  can,  of  course,  have 
no  existence  independent  of  their  mother,  and  are  not, 
therefore,  likely  to  become  the  subject  of  medico- 
legal  inquiry.  Anencephalic  monsters  may  at  times, 
however,  have  a  medulla  dblongata  and  cerebellum  and 
may  be  born  aiive ;  there  are  recorded  instances  of 


SEX,  HERMAPHRODISM,  ETC.  179 

such  a  child  having  lived  from  one  and  a  half  hours  to 
two  months. 

Children  having  deformities  resulting  from  structural 
deficiency,  such  as  the  absence  of  arms,  nose,  etc.,  but 
having  the  vital  organs  perfect,  as  well  as  children  hav- 
ing congenital  deformities  arising  from  a  redundancy  of 
parts,  are  occasionally  born  and  live  to  adult  age.  No 
medico-legal  questions,  however,  will  arise  respecting 
such  persons,  as  they  have  all  the  rights  of  persons 
without  any  structural  defect.  Occasionally  double 
monsters  are  born,  where  the  children  are  more  or  less 
distinct  above  and  below,  being  united  by  a  band  of 
greater  or  less  width  extending  from  the  thorax  and 
abdomen  of  one  child  to  the  thorax  and  abdomen  of  the 
other;  or  where  the  union  exists  between  the  back  and 
pelvis  or  between  the  head  and  scalp.  Another  class 
of  double  monsters  is  where  the  union  is  deep  and  inti- 
mate and  more  or  less  complete,  —  as  where  the  children 
are  single  above  and  double  below;  or  double  above 
and  single  below ;  or  where  the  bodies  of  the  two  chil- 
dren are  so  connected  that  they  form  a  single  body  with 
a  head  at  each  end. 

As  to  the  medico-legal  aspects  of  monstrosities,  the 
only  cases  likely  to  demand  the  attention  of  the  medi- 
cal jurist  are  those  of  doubtful  sex  or  hermaphrodism 
already  considered,  and  those  of  monsters  not  possessing 
the  shape  of  mankind.  As  to  the  latter,  it  seems  that 
no  such  human  monster  that  has  lived  to  adult  age 
could  be  denied  human  shape ;  and  we  quite  agree  with 
Dr.  Tidy  in  saying  that  "it  would  constitute  an  almost 
unrecorded  case  where  the  jurist  would  be  justified  in 
saying  without  reserve  that  a  child  b<#n  alive  had  not 


180  MEDICAL  JURISPRUDENCE. 

the  shape  of  mankind,  —  implying  as  the  phrase  does, 
far  more  than  mere  deformity." 

It  is  very  clear  that  by  the  common  law  no  degree 
of  monstrosity  in  a  child  will  warrant  the  destruction 
of  its  life  either  by  a  physician  or  friend. 


CHAPTER  XV. 

LEGITIMACY  AND   PATERNITY. 

A  LEGITIMATE  child,  according  to  Blackstone,  is  he 
that  is  born  in  lawful  wedlock  or  within  a  competent 
time  afterwards  ;  and  a  bastard  is  one  that  is  not  only 
begotten  but  born  out  of  lawful  matrimony.  According 
to  the  statute  in  the  State  of  Illinois,  an  illegitimate 
child  whose  parents  have  intermarried,  and  whose  father 
has  acknowledged  him  or  her  as  his  child,  shall  be  con- 
sidered legitimate.  By  the  civil  and  canon  laws  the 
intermarriage  of  the  parents  after  the  birth  of  a  child, 
legitimates  such  child. 

It  seems  that  a  child  born  after  the  death  of  its 
mother  as,  for  example,  by  Csesarean  section,  is  legiti- 
mate although  begotten  before  the  intermarriage  of  the 
parents. 

Every  child  born  in  wedlock  is  to  be  regarded  as 
legitimate  unless  impossibility  of  access  or  impossibility 
of  intercourse  with  the  husband  can  be  proved  by  com- 
petent witnesses  other  than  the  husband  or  wife.  A 
posthumous  child  will  be  legitimate  unless  non-access, 
impotence,  or  sterility  can  be  proved.  According  to 
Lord  Coke,  "  if  a  man  hath  a  wife  and  dieth,  and  within 
a  very  short  time  after  the  wife  marrieth  again,  and 
within  nine  months  hath  a  child,  so  as  it  may  be  the 


182  MEDICAL  JURISPRUDENCE. 

child  of  one  or  the  other,  some  have  said  in  this  case 
the  child  may  choose  his  father." 

Medico-legal  questions  relating  to  disputed  paternity 
may  arise  as  to  posthumous  children;  as  to  children 
born  either  shortly  after  marriage  or  after  the  prolonged 
absence  of  the  husband;  or  in  cases  where  a  second 
child  is  born  a  short  time  after  the  birth  of  another 
child ;  where  a  child  is  born  soon  after  a  second  mar- 
riage following  the  death  of  the  first  husband  or  a 
divorce  from  him  in  cases  where  the  decree  of  nullity 
is  not  on  the  ground  of  impotence,  which  has  already 
been  considered  ;  and  lastly,  in  cases  of  supposititious 
children,  where  the  woman  during  the  life-time  of  her 
husband  pretends  to  have  given  birth  to  a  child  and  is 
suspected  of  substituting  for  the  purpose  of  fraud  the 
child  of  some  other  person.  These  questions  may  be 
considered  under  the  following  heads  :  — 

1.  Impotence  and  Sterility. 

2.  Duration  of  Pregnancy. 

3.  Similarity  or  Likeness. 

4.  Supposititious  children. 

1.  Impotence  and  sterility.  —  Fruitfulness  results 
when  a  spermatozoon  from  the  seminal  fluid  of  the  male 
meets  and  becomes  incorporated  with  an  ovum  dis- 
charged from  the  ovary  of  the  female.  The  essential 
conditions  of  fruitfulness  then,  are  the  existence  of  an 
ovum  capable  of  impregnation  and  the  presence  of 
active  spermatozoa.  Impregnation  may  result  alto- 
gether independently  of  sexual  intercourse. 

By  impotence  is  meant  inability  for  sexual  inter- 
course ;  thus  a  male  having  no  penis  or  a  female  no 
vagina  would  respectively  be  impotent.  The  subject 


LEGITIMACY  AND  PATERNITY.  183 

of  impotence,  so  far  as  it  relates  to  the  subject  of  divorce, 
has  been  considered  in  another  chapter. 

By  sterility  is  meant  an  inability  to  conceive  and  to 
procreate  ;  a  male  whose  semen  contains  no  spermatozoa, 
or  a  female  without  ovaries,  would  respectively  be 
sterile.  We  have  already  seen  in  another  chapter  that 
mere  sterility,  whether  in  the  man  or  woman,  is  not  in 
itself  sufficient  ground  for  avoiding  marriage  unless  it 
is  also  accompanied  by  an  irremediable  incapacity  for 
sexual  intercourse. 

Impotence  and  sterility  in  the  man  may  arise  from 
the  male's  not  having  arrived  at  the  age  of  puberty. 
By  the  English  common  law  the  age  of  consent  to 
marriage  is  fixed  at  fourteen  in  the  male  and  twelve  in 
the  female ;  and  it  is  generally  held  that  by  the  com- 
mon law  a  rape  cannot  be  committed  by  a  boy  under 
fourteen  years  of  age.  Although  puberty  may  be  con- 
sidered as  commencing  somewhere  about  the  age  of 
fourteen  in  both  sexes,  exceptions  to  this  rule  are  not 
uncommon  ;  puberty  is  not  unfrequently  long  deferred, 
and  again,  there  are  recorded  instances  where  boys  have 
arrived  at  the  age  of  puberty  very  early.  Dr.  Tidy 
records  one  case  where  the  boy  arrived  at  puberty  at  the 
age  of  four  and  a  half  years. 

So  far  as  respects  the  question  of  impotence  and 
sterility  in  cases  other  than  criminal  prosecutions  for 
rape,  if  unequivocal  signs  of  puberty  exist,  the  boy 
should  be  regarded  as  virile,  no  matter  how  young  ;  and 
if,  on  the  other  hand,  signs  of  puberty  are  absent,  the 
medical  jurist  has  no  ground  for  affirming  the  possession 
of  virile  power,  however  great  the  age. 

There  is  no  age  beyond  which  parties  may  not  legally 


184  MEDICAL  JURISPRUDENCE. 

marry ;  and  although  old  age  usually  lessens  the  virile 
power,  it  cannot  be  regarded  as  negativing  sexual  fruit- 
fulness  or  capacity.  Old  age  does,  however,  unquestion- 
ably render  the  occurrence  of  paternity  less  probable. 
In  such  cases,  however,  the  real  question  is  not  so  much 
the  age  of  the  man  as  whether  his  semen  contains 
spermatozoa.  Dr.  Tidy  says  that  he  has  more  than 
once  detected  spermatozoa  in  the  semen  of  men  over 
ninety,  and  Casper  records  a  case  where  he  found  them 
in  a  man  aged  ninety-six. 

The  subject  of  impotence  and  sterility  arising  from 
accidental  injuries  or  congenital  defects  or  malforma- 
tions of  the  sexual  organs — such  as  hermaphrodism, 
hypospadias,  epispadias,  etc.  —  have  been  considered  in 
another  connection.  In  all  these  cases,  so  far  as  re- 
spects the  question  of  legitimacy  and  paternity,  the 
principal  points  for  inquiry  are,  — 

Firstly,  whether  there  is  a  urethra  capable  of  per- 
mitting the  passage  of  the  seminal  fluid,  and  whether  it 
is  so  placed  that  the  opening  may  in  copulation  come 
into  contact  with  any  part  of  the  vagina. 

Secondly,  whether  the  individual  has  a  testicle  or 
testicles.  It  is  certain  that  fruitful  intercourse  may 
result  in  the  case  of  monorchids,  that  is,  individuals 
having  only  one  testicle,  or  where  only  one  testicle  has 
descended  into  the  scrotum.  As  respects  the  very  rare 
cases  of  crypsorchids,  that  is,  where  neither  testicle  has 
descended  into  the  scrotum,  it  may  be  stated  that  they 
are  not  necessarily  impotent.  As  respects  the  question 
whether  they  are  sterile,  recorded  cases  seem  to  estab- 
lish the  fact  that  a  retained  testicle  does  not,  as  a  rule, 
secrete  prolific  semen,  and  hence  that  they  are  generally 


LEGITIMACY  AND  PATERNITY.  185 

sterile.  Casper,  however,  and  Professor  Owen  have 
recorded  cases  not  only  of  the  existence  of  sperma- 
tozoa in  the  semen  but  of  the  possession  of  undoubted 
virility. 

The  removal  of  both  of  the  testicles  by  operation 
certainly  causes  sterility ;  but  it  seems  to  be  settled 
that,  probably  owing  to  the  retention  of  semen  in  the 
vesiculce  seminales,  the  individual  may  for  a  limited 
period  be  capable  of  impregnating  an  ovum ;  and  if 
the  secreting  structure  of  the  testicles  is  not  entirely 
removed,  it  seems  clear  that  spermatozoa  may  be 
formed. 

Where  the  testicles  are  congenitally  absent  the  per- 
son will,  according  to  Dr.  Tidy,  invariably  be  found  to 
be  of  a  languid  disposition,  slenderly  formed,  beardless, 
with  a  shrill  voice,  undeveloped  genitals,  and  an  absence 
of  sexual  desires.  Where  the  testicles  have  not  de- 
scended the  development  has  been  found,  in  some  cases, 
to  be  in  all  respects  manly  and  complete,  and  in  others 
to  be  of  a  more  or  less  womanly  character.  Where 
the  testicles  have  been  removed  by  operation  a  scar 
will  always  be  found ;  in  these  cases  if  the  testicles  are 
removed  in  infancy  the  result  will  be  much  the  same 
as  where  they  are  congenitally  absent.  If  the  testicles 
are  removed  after  puberty,  as  a  general  rule  the  mascu- 
line character  is  retained,  although  exceptional  instances 
to  the  contrary  are  recorded. 

Impotence  and  sterility  of  the  male  may  be  caused 
by  a  variety  of  diseases,  such  as  cancerous,  tubercu- 
lous, or  syphilitic  diseases  of  the  testicles  or  penis  ; 
an  obstruction  of  the  excretory  ducts  from  double 
epididymitis  following  gonorrhoea.  The  ejaculation  of 


186  MEDICAL  JURISPRUDENCE. 

semen  may  also  be  prevented  by  urethral  stricture  and 
by  other  pathological  conditions.  Certain  general  dis- 
eases, such  as  paraplegia,  may  also  cause  sterility  by 
preventing  sexual  intercourse,  especially  so  if  accom- 
panied with  atrophy  of  the  testicles.  There  are  certain 
recorded  instances  where  mumps  has  caused  sterility 
in  both  sexes.  Lithotomy  has  been  known  to  cause 
sterility  in  the  male  by  interference  with  the  ejacula- 
tory  ducts.  Finally,  any  cause  which  decreases  the 
bodily  vigor  probably  decreases  sexual  power;  but 
there  are  recorded  instances  in  which  coitus  in  an 
advanced  state  of  phthisis  or  heart  disease  has  beeu 
followed  by  pregnancy,  although  the  coitus  took  place 
only  a  few  hours  before  death. 

Masturbation  may  be  a  cause  both  of  sterility  and 
impotence. 

Impotence  and  sterility  may  arise  from  the  action  of 
certain  poisons,  notably  alcohol,  opium,  tobacco,  lead,  and 
gonorrhoeal  virus ;  the  last  mechanically  by  producing 
stricture  of  the  urethra  or  of  the  seminal  ducts.  As  to 
the  poisons  above  mentioned  other  than  the  gonorrhoeal 
virus,  in  the  majority  of  cases  it  is  perhaps  doubtful 
whether  their  effects  have  not  been  exaggerated. 

Impotence  and  sterility  in  woman  may  arise  from  a 
variety  of  causes.  Impotence  such  as  will  warrant  a 
decree  for  a  divorce  is  extremely  rare  ;  this  subject  has, 
however,  been  considered  in  another  chapter. 

Sterility  may  arise  from  extremes  of  age.  The  genera- 
tive power  in  woman  is  generally  supposed  to  commence 
with  the  appearance,  and  end  with  the  disappearance  of 
menstruation.  The  menses,  or  catamenia,  from  the 
arrival  of  puberty  to  the  menopause  or  cessation  of 


LEGITIMACY  AND   PATERNITY.  187 

menstruation  occur,  as  a  rule,  at  regular  intervals  of 
twenty-eight  days  from  the  beginning  of  one  to  the 
commencement  of  the  next  monthly  hemorrhage.  The 
fluid  discharged  consists  chiefly  of  blood  and  coincides 
in  point  of  time  with  the  discharge  of  the  ovum  from 
the  ripened  Graafian  follicles  of  the  ovary ;  the  blood 
discharged  has  been  supposed  to  be  deficient  in  fibrin 
and  is  generally  changed  in  color  from  admixture  with 
vaginal  secretions.  Epithelial  scales  from  the  vagina 
and  uterus  will,  as  a  rule,  be  found  in  such  discharge. 
This  flow  may  last  from  a  few  hours  to  several  days, 
from  three  to  four  and  a  half  days  being  the  average 
period.  The  amount  discharged  may  vary  from  a  few 
drops  to  many  ounces ;  an  average  quantity  being  from 
four  to  six  ounces.  Although  the  average  interval,  as 
above  stated,  is  twenty-eight  days,  the  flow  may  be 
anticipated  or  retarded  by  a  variety  of  causes,  and  in 
some  instances  the  normal  interval  varies  within  con- 
siderable limits.  In  cold  countries  the  interval  is  said 
to  be  longer  than  in  warm  countries.  As  a  rule, 
menstruation  is  said  to  begin  in  temperate  climates 
somewhere  between  the  ages  of  fourteen  and  sixteen,  — 
the  usual  earliest  periods  being  twelve  to  thirteen, 
and  the  latest  periods  nineteen  to  twenty-three  years, 
although  exceptional  instances  of  primary  menstruation 
have  been  recorded  as  early  as  one  year  and  as  late  as 
forty-seven  ;  primary  menstruation,  however,  before  the 
age  of  nine  and  after  twenty  is  exceedingly  uncommon. 
"With  female  puberty  come  certain  changes, — namely, 
deposit  of  fat  in  the  subcutaneous  cellular  tissue,  caus- 
ing first  a  slight  swelling  in  the  groins,  extending  over 
the  whole  body,  more  particularly  the  breasts ;  growth 


188  MEDICAL  JURISPRUDENCE. 

of  hair  in  the  arm-pits  and  upon  the  genitals,  while  the 
hair  of  the  head  often  assumes  a  darker  appearance; 
the  voice  changes  from  its  childish  quality  to  the 
characteristic  voice  of  woman. 

The  catamenia,  as  a  rule,  cease  between  forty-two  and 
forty-eight,  although  there  are  numerous  exceptions. 
As  a  rule,  those  who  develop  early  fade  early;  and 
there  are  recorded  cases  where,  after  the  change  of  life 
seemed  complete,  menstruation  reappeared  and  contin- 
ued to  a  late  period.  The  fruitful  period  in  woman  is 
generally  limited  to  the  interval  between  the  first  and 
last  menstruation,  but  it  is  an  established  fact  that 
menstruation  may  occur  without  ovulation.  There  are 
recorded  cases  of  so-called  menstruation  from  birth,  but 
the  earliest  recorded  case  of  pregnancy  was  between 
eight  and  nine  years. 

As  to  whether  ovulation  may  occur  without  menstru- 
ation, there  is  no  doubt ;  recorded  cases  of  the  concep- 
tion of  women  who  have  never  menstruated  furnish 
important  evidence  upon  this  point.  There  are  also 
recorded  cases  of  women  conceiving  who  menstruated 
regularly  before  marriage  and  irregularly  or  not  at  all 
during  their  child-bearing  life ;  and  there  are  also  cases 
of  conception  after  the  menopause.  As  to  what  time 
during  the  monthly  period  the  ovum  is  discharged  from 
the  ovary,  there  is  much  doubt ;  it  may  be  regarded  as 
settled,  however,  that  while  pregnancy  is  more  apt  to 
follow  a  few  days  after  the  cessation  of  the  monthly  flow, 
or  a  day  before  its  commencement,  conception  may  take 
place  at  any  time  during  the  interval.  As  to  the  age 
beyond  which  conception  is  impossible,  the  limit  doubt- 
less varies  with  different  women ;  and  while,  as  a  rule, 


LEGITIMACY  AND  PATERNITY.  189 

ability  to  conceive  ceases  with  the  menopause,  there 
are,  as  we  have  stated,  recorded  cases  occurring  after 
that  time.  It  is  not  possible,  perhaps,  for  the  medical 
jurist  to  fix  upon  any  age  before  or  after  which  he  will 
be  justified  in  stating  that  pregnancy  is  impossible. 
Pregnancies  up  to  fifty  are  not  very  uncommon ;  between 
fifty  and  sixty,  although  there  are  some  well  authenti- 
cated instances,  the  cases  are  very  uncommon,  while 
there  are  recorded  cases  above  the  age  of  sixty,  and 
even  as  late  as  seventy;  these  cases,  however,  do  not 
seem  entitled  to  much  credit. 

Impotence  and  sterility  in  women  may  arise  from 
congenital  and  other  defects,  such  as  the  absence  of  the 
vulva  and  external  genital  organs;  absence  of  the  vagina ; 
absence  of  a  uterus,  which  may  or  may  not  coexist  with 
an  absence  of  the  vagina ;  or  entire  absence  of  ovaries, 
which,  however,  could  not  be  demonstrated  during  life. 

Sterility  may  be  caused  by  the  non-performance  of 
their  normal  functions  by  the  ovaries,  or  by  some  inter- 
ference with  the  passage  of  the  ovum  from  the  ovary  to 
the  uterus,  arising  from  alteration  in  the  coverings  of 
the  ovary,  in  the  Fallopian  tubes,  etc. ;  it  may  arise  from 
alterations  in  the  uterus  or  vagina  which  prevent  the 
impregnation  of  the  ovum  or  access  to  it  by  the  sper- 
matozoa; or  from  the  destructive  action  of  unhealthy 
fluids  of  the  uterus  or  the  vagina  upon  the  spermatozoa. 
Diseases  and  displacements  of  the  uterus,  contractions 
of  the  os  uteri  and  the  cervical  canal,  tumors  in  the 
uterine  cavity,  etc.,  may  also  cause  sterility. 

As  a  general  rule,  women  do  not  conceive  during 
lactation,  but  the  exceptions  to  this  rule  are  not  in- 
frequent. Promiscuous  intercourse,  as  by  prostitutes, 


190  MEDICAL  JURISPRUDENCE. 

from  the  inflammatory  condition  of  the  Fallopian  tubes 
thereby  induced,  frequently  renders  impregnation  less 
likely  to  occur.  The  habit  of  abortion  at  an  early  period 
of  pregnancy  often  practically  amounts  to  sterility. 

The  full  consideration  of  this  subject,  however,  is 
beyond  the  scope  of  this  manual ;  the  student  is  referred 
for  further  particulars  to  professed  treatises  on  obstetrics 
and  gynaecology. 

A  microscopical  examination  of  the  semen  to  ascer- 
tain whether  it  contains  spermatozoa,  and  if  it  does 
contain  them  whether  they  are  alive,  is  often  an  im- 
portant aid  in  determining  the  question  of  sterility. 

2.  The  duration  of  pregnancy,  etc.,  has  an  important 
bearing  upon  questions  of  legitimacy  and  paternity. 
The  signs  of  pregnancy,  time  of  quickening,  etc.,  have 
already  been  considered  in  another  connection.  As  to 
its  duration,  it  is  impossible  to  fix  definitely  a  period  of 
utero-gestation.  Although  some  foreign  codes  of  juris- 
prudence have  attempted  to  fix  the  time  beyond  which 
utero-gestation  cannot  extend,  the  common  law  has  more 
properly  left  each  case  to  be  decided  according  to  the 
evidence  introduced ;  forty  weeks,  however,  or  two  hun- 
dred and  eighty  days,  is  commonly  regarded  as  the 
period  of  pregnancy. 

Dr.  Tidy,  in  the  consideration  of  this  subject,  states 
that  there  is  a  general  consent  among  the  best  of  ob- 
stetricians as  to  the  duration  of  pregnancy,  the  ex- 
tremes being  266  days,  or  38  weeks,  to  280  days,  or  40 
weeks. 

Duncan,  from  analysis  of  46  cases,  in  which  connec- 
tion took  place  during  a  single  day  only,  found  the 
average  time  to  the  date  of  parturition  to  be  275 


LEGITIMACY  AND  PATERNITY.  191 

days.  Ahfeld,  from  analysis  of  425  cases,  obtained  an 
average  of  271  days.  Hecker,  from  108  cases,  found 
the  average  to  be  273.5  days.  Veit,  from  43  cases, 
found  an  average  of  276.4  days.  Faye,  from  63  cases, 
found  an  average  of  270.7  days. 

While  these  averages  show  that  the  date  of  a  particu- 
lar confinement  will  probably  occur  at  the  time  indi- 
cated thereby,  the  fact  that  in  Ahfeld's  table  there  exists 
between  the  longest  and  shortest  gestation  a  difference 
of  99  days,  in  Hecker's  a  difference  of  63  days,  and  in 
Veit's  a  difference  of  36  days,  shows  that  too  much 
reliance  should  not  be  placed  upon  such  averages.  The 
bulk  of  confinements,  however,  vary  within  narrow 
limits.  According  to  Lusk,  of  653  women,  in  15.93 
per  cent  delivery  occurred  in  the  38th  week ;  in  27.56 
per  cent,  in  the  39th  week ;  in  26.19  per  cent  in  the 
40th  week;'  in  10.01  per  cent  in  the  41st  week.  Thus 
in  more  than  half  the  cases  delivery  occurred  in  the 
39th  and  40th  weeks,  and  80  per  cent  occurred  between 
the  38th  and  41st  weeks  inclusive.  Of  the  remainder, 
14  per  cent  took  place  prior  to  the  38th  week,  and^ 
according  to  Dr.  Lusk,  were  probably  influenced  by 
many  operative  accidental  causes  which  favor  prema- 
turity. Of  the  6  per  cent  reported  as  occurring  later 
than  the  41st  week,  a  considerable  number  he  re- 
gards as  of  questionable  authenticity,  as  in  his  opinion 
gestation  protracted  beyond  the  285th  day  is  certainly 
of  very  rare  occurrence. 

The  extent  to  which  the  normal  period  of  utero- 
gestation  may  be  shortened,  and  a  living  child  never- 
theless be  born,  is  one  of  great  importance.  In  questions 
of  this  sort,  two  points  usually  arise  for  consideration : 


192  MEDICAL  JURISPRUDENCE. 

first,  whether  a  child  of  the  age  stated  or  estimated  is 
viable,  —  that  is,  of  such  an  age  as  to  be  capable  of 
showing  some  indications  of  live  birth  after  it  is  com- 
pletely external  to  the  mother ;  and  secondly,  whether, 
if  it  is  alive  when  born,  it  is  probable  that,  at  the  age 
stated  or  estimated,  it  can  be  reared. 

Dr.  Tidy  draws  the  following  practical  conclusions 
from  the  consideration  of  a  large  number  of  cases  of 
abnormally  shortened  utero-gestation :  — 

1.  Allowing  that  from  the  first  moment  of  impreg- 
nation the  ovum  is  truly  alive,  and  further  that  mere 
motion  of  limbs,  or  evidence  of  circulation  without  ac- 
tive respiration,  are  sufficient  to  constitute  live  birth,  — 
nevertheless,  there  is  no  evidence  to  show  that  a  foetus 
born  at  an  earlier  period  than  between  the  fourth  and 
fifth  months  of  uterine  existence  can  in  any  sense  be 
said  to  be  born  alive,  much  less  lead  an  independent 
life  apart  from  its  mother. 

2.  That  living  children  have  been  born  between  the 
fourth  and  fifth  months  of  uterine  life.     As  a  rule,  how- 
ever, the  only  sign  of  life  exhibited  by  children  born 
at  this  early  period  is  a  slight  motion  of  the  limbs, 
although  cases  of  somewhat  more  active  vitality  have 
been  recorded.     There  is,  however,  no  well  authenti- 
cated case  where  a  less  than  five  mouths'  child  has 
lived  beyond  twenty-four  hours  after  its  birth,  and  but 
one  where  it  has  lived  twenty-four  hours. 

3.  That  children  born  alive  at  the  fifth  or  between 
the  fifth  and  sixth  months  of  utero-gestation  mostly  die 
after  a  few   hours.     Nevertheless,  there  is   a  limited 
number  of  recorded  cases  where   such  children  have 
been  reared,  and  have  even  reached  adult  age. 


LEGITIMACY  AND  PATERNITY.  193 

4.  That  several  well-authenticated  cases  exist  where 
children  born  between  the  sixth  and  seventh  months, 
and  even  at  the  sixth  month,  have  reached  adult  age ; 
but  that  in  such  cases  more  than  ordinary  care  and  at- 
tention have  been  needed  to  maintain  life,  at  least  for 
some  time  after  birth. 

Signs  of  Maturity  in  New-born  Children.  —  Although 
children  born  at  full  term  vary  in  size,  weight,  etc., 
there  are  certain  signs  of  maturity  which  should  be 
considered  in  this  connection.  Among  these  signs  are, — 

1.  A  certain  general  habitus  familiar  to  experts. 

2.  The  color  of  the  skin  of  a  mature  child  is  paler 
than  in  one  less  mature,  while  the  down  (lanugo)  to  a 
great  extent  disappears  with  maturity.     It  is  said  that 
certain  white  points  found  in  many  cases  on  the  a  Ice  of 
the  nose,  cheeks,  and  forehead,  but  especially  on  the 
chin  and  under  lip, — due  to  the  dilatation  of  the  excre- 
tory ducts  of  the  sebaceous  follicles,  —  are  abundant  in 
proportion  to  the  immaturity  of  the  foetus,  decreasing 
in  number  as  full  term  approaches ;  at  full  term  they 
are  only  to  be  found  on  the  tip  of  the  nose. 

3.  At  maturity  there  is  more  or  less  hair  on  the 
head. 

4.  The  immobility  of  the  skull  bones,  —  the  anterior 
fontanelle  averaging  f  to  1  inch  in  length. 

5.  A  certain  height  and  weight.     The  average  height 
of  new-born  children  of  both  sexes,  born  at  full  term,  is 
between  18  and  19  inches.     Of  247  mature  children  of 
both  sexes,  the  average  length  is  stated  by  Dr.  Tidy  to 
have  been  18 1  inches.     Average  length  of  the  males 
(130)  was  19|  inches;  of  the  females  (117)  18f.     The 
maximum  recorded  length  was  22  inches ;  the  minimum, 

13 


194  MEDICAL  JURISPRUDENCE. 

16.  The  average  weight  of  a  mature  infant  at  birth  is 
probably  between  6  and  7  pounds.  Dr.  Tidy  states  that 
the  average  weight  of  English  children  at  birth  is  6 
pounds,  8  ounces.  The  average  weight  of  247  mature 
children  of  both  sexes  is  stated  by  him  to  be  7^ 
pounds;  of  130  males,  7J;  of  117  females,  6f  The 
maximum  recorded  weight  of  these  children  was  10 
pounds,  and  the  minimum,  4|  pounds.  It  is  said  that 
the  weight  and  length  of  Indian  children  are  less  than 
those  of  European  children. 

Casper  quotes    from   Gunz   the   following   table   of 
dimensions  of  the  bones  of  a  mature  child :  — 

Inches.     Lines. 

Height  of  the  frontal  part  of  the  frontal  bone     ....  2  3 

Breadth  of  the  same 1          10 

Length  of  the  pars  orbitalis 1 

Breadth  of  the  same 1 

Parietal  bone  from  anterior  superior  angle  to  inferior  pos- 
terior one 3  3 

Ditto  from  anterior  inferior  angle  to  superior  posterior  one  3  3 

Height  of  pars  occipitalis  of  os  occipitis 2 

Breadth  of  the  same 1          10 

Height  of  squamous  portion  of  temporal  bone  from  upper 

edge  of  auditory  foramen 1 

Height  of  malar  bone    .     .     .     .;  .,  *•  *    Ji*/Kt»f-*     •  ^ 

Breadth  of  the  same 1 

Height  of  nasal  bone 5 

Breadth  of  the  same 3 

Height  of  the  superior  maxillary  bone  from  the  proccssus 

alveolaris  to  the  apex  of  the  proccssus  nasalis   ...  1 
Length  of  the  superior  maxillary  bone  from  the  anterior 

nasal  spine  to  the  apex  of  the  proccssus  sygomaticus  .  1  1 

Length  of  each  half  of  the  lower  jaw 1          10 

Breadth  of  the  lower  jaw 7 

Length  of  the  seven  cervical  vertebrae 1  3 

"       "      twelve  dorsal       "  39 


LEGITIMACY  AND  PATERNITY.  195 

Inches.  Lines. 

Length  of  the  five  lumbar  vertebrae 2  3 

"       "      sacrum  and  coccyx 2  3 

"       "      collar  bone 1  7 

"       "      shoulder  blade 1  6 

Breadth  of  the  shoulder  blade 1  2 

Length  of  the  humerus 3 

"       "      ulna 2  10 

"       "      radius 2  8 

"       "      femur 3  6 

"       "      patella 9 

Breadth  of  the  patella 8 

Length  of  the  tibia 3  2 

"      "      fibula 3  1 

It  is  laid  down  as  a  general  rule  that  still-born 
children  are  heavier  and  longer  than  those  born  alive ; 
males  than  females,  and  single  children  and  twins  than 
triplets. 

6.  The  diameter  of  the  head  and  measurements  across 
the  shoulders  and  hips,  according  to  Casper,  afford  val- 
uable evidence  of  maturity.  Of  207  children  he  found 
the  average  transverse  diameter  of  the  head  3£  inches ; 
longitudinal  diameter,  4-|  inches ;  diagonal  diameter, 
4|  inches.  Tardieu  makes  the  occipito-frontal  diameter 
from  4^  to  4J  inches,  and  the  biparietal  from  3|  to  3f. 

According  to  Lusk,  whose  table  is  based  upon  that  of 
Tarnier  and  Chantreuil,  the  diameters  of  the  fetal  head 
are  as  follows :  — 

Occipito-mental  diameter 5J  inches. 

Occipito-frontal         "         4J 

Sub-occipito-bregmatic       3| 

Bi-parietal , 3| 

Bi-temporal 3| 

Bi-mastoid 3 

Fronto-mental 3J 

Cervico-bregmatic 3f 


196  MEDICAL  JURISPRUDENCE. 

According  to  Casper  the  average  diameter  across  the 
shoulders  in  117  mature  children  was  4^|,  and  across 
the  hips,  3^  inches. 

7.  Condition  of  the  nails.  —  In  mature  children  the 
nails  are  horny  and  reach  the  tips   of  the  fingers,  al- 
though not  necessarily  so  in  the  case  of  the  toes. 

8.  The   cartilages  of  the  ears  and  nose  of  a  mature 
child  feel  cartilaginous. 

9.  Condition  of  the  genitals.  —  In  mature  male  chil- 
dren the  testicles  will  both  be  in  the  scrotum,  which 
will  be  corrugated.     In  about  three  or  four  per  cent  of 
cases,  according  to  Dr.  Tidy,  one  of  the  testicles  will  not 
have  descended  at  birth ;  it  is  rare  to  find  both  testi- 
cles undescended.     In  mature  female  children  the  labia 
majora  should  cover  the  vagina  and  clitoris ;  there  are, 
however,  numerous  exceptions  to  this  rule. 

10.  Position  of  the  Umbilicus.  —  The  navel  is  usually 
in  the  centre  of  the  body  of  a  mature  child ;  there  are, 
however,  numerous  exceptions  to  this  rule. 

11.  Weight  of  the  placenta  and  length  of  the  cord.  — 
The  placenta  at  full  term  usually  has  a  diameter  from 
8  to  10  inches,  and  weighs  from  15  to  19  ounces.     The 
length  of  the  cord  at  full  term  is  stated  by  Tidy  to  vary 
from  18  to  21  inches. 

12.  Ossification  of  bones,  etc.  —  Where   the  child  is 
born  dead  the   following   sign    is    of  value :     In  the 
second   half  of  the  tenth  lunar  month,  the  centre  of 
ossification  of  the  inferior  femoral  epiphysis  makes  its 
appearance ;  this  centre  of  ossification  is  to  be  demon- 
strated by  carefully  making  horizontal  sections  off  from 
the  cartilaginous  epiphysis  until  a  colored  point  is  ob- 
served, the  greatest  diameter  of  which  osseus  nucleus  is 


LEGITIMACY  AND  PATERNITY.  197 

to  be  measured.  To  the  naked  eye  this  nucleus  appears 
as  a  more  or  less  circular  blood-red  spot  in  the  midst  of 
milk-white  cartilage,  in  which  vascular  convolutions 
may  be  distinctly  recognized. 

If  there  is  no  visible  trace  of  this  osseous  nucleus,  the 
foetus  cannot  be  more  than  from  36  to  37  weeks  old ; 
if  it  is  of  the  size  of  a  hemp-seed  (about  half  a  line),  it 
corresponds  to  37  or  38  weeks,  if  still-born ;  when  from 
3-4  to  3  lines  it  indicates  a  uterine  age  of  about  40 
weeks ;  if  it  measures  more  than  3  lines  the  child  has 
probably  survived  its  birth. 

The  following  table  quoted  by  Tidy  from  Tardieu, 
shows  the  character  of  the  foetus  at  different  ages  of 
intra-uterine  development. 


198 


MEDICAL  JURISPRUDENCE. 


Table  showing  the  Character  of  the  Foetus  at  different  Ages  of  Intro- 
Uterine  Life. 


Age. 

General  DeTelopment 
of  the  Body. 

State  of  the  Skin,  etc. 

Degree  to  which 
Ossification  has 
advanced. 

Height. 

Weight. 

From  1  month 

|-f  inch. 

15-46  grs. 

ISkin  quite  trans- 

Centres of  ossifica- 

to 1.J  months. 

parent,   of  a  pur- 

tion for  clavicles  and 

From  li  to  2 

j-2  inches. 

77-165  " 

plish-red  color,  with 

lower  jaw.     Appear- 

months. 

no    trace    of    hair 

ance  of  dental  papil- 

From   the   2d 

2-4     " 

3  vj-li  oz. 

on  it. 

lae  in  the  furrow  of 

to  the  3d  month. 

the  lower  jaw. 

From  the  3d  to 
the  4th  month. 

4-6     " 

ljox.-4joz. 

DeTelopment  of 
nails.    Appearance  of 

Centre  of  ossifica- 
tion in  ischium. 

matrix  of  nail.    Sex 

distinct. 

From  the  4th  to 

6-8     " 

6-8  oz. 

Hair-germs  appear 

Ossification  of  os 

the  6th  month. 

on  the  forehead  and 

calcis. 

eyebrows. 

From  the  5th  to 

10-12" 

8-12oi. 

Hairs  appear  on  the 

Osseous  centres  for 

the  6th  month. 

limbs. 

astragalus  and  os 

pvbis. 

From  the  6th  to 

12-14  " 

15-3201. 

Hairs  on  hands  and 

Three  or  four  osse- 

the 7th  month. 

feet.   Alembrana  pu- 

ous  centres  in  ster- 

pillaris begins  to  dis- 

num. 

appear. 

From  the  7th  to 

14-16  " 

2-3  pounds. 

Skin    has    lost    its 

Ossification  of  low- 

the 8th  month. 

r.jJ     J."iJ 

transparency.      Epi- 

er  vertebrae  of   sa- 

dermis distinct.  Color 

crum. 

pale  pink. 

From  the  8th  to 

16-18  " 

3-6     " 

Skin  is  covered  with 

the  9th  month. 

sebaceous    materials. 

(  Vernix      caseosa.) 

The  nails  do  not  reach 

tips  of  fingers. 

At  term 

18-20  " 

6-7     " 

Sebaceous  covering 

An  osseous  nucleus 

(mature). 

still    thicker.      Nails 

in  the  condyloid  epi- 

overlap  fingers. 

physis     of   femur. 

Membrana  pupilla- 

The     alveolar     pro- 

rig has  quite   disap- 

cesses of    the  lower 

peared.  Navel  a  little 

jaw  are  perfectly  dis- 

below middle  of  en- 

tinct. 

tire  length  of  body. 

The  student  will  find  an  extended  consideration  of 
the  evidence  of  the  development  of  the  fcetus  in  2 
"  Tidy's  Legal  Medicine,"  pages  59  to  64  inclusive. 


LEGITIMACY  AND  PATERNITY. 


199 


13.  The  extent  to  which  the  normal  period  of  utero- 
gestation  may  be  lengthened,  in  practice  must  be 
reckoned  from  the  latest  possible  day  of  access  of  the 
husband,  which  in  most  cases  would  be  the  date  of  his 
death,  departure  abroad,  or  the  like.  That  the  period  of 
utero-gestation  may  be  considerably  prolonged  beyond 
the  average  period,  there  can  be  no  doubt ;  but,  as  has 
already  been  stated,  by  the  law  in  some  countries  a 
definite  period  is  fixed  beyond  which  the  child  born  is 
regarded  as  illegitimate.  Thus  in  Scotland  a  child  born 
six  months  after  the  marriage  of  the  mother  or  within 
ten  months  after  the  death  of  the  father,  is  considered 
legitimate.  In  France  the  limit  is  fixed  at  300  days ; 
the  Prussian  code,  without  absolutely  declaring  children 
born  in  the  llth  month  illegitimate,  attaches  such  con- 
ditions to  the  proof  of  their  legitimacy  as  to  make  it 
almost  unattainable.  By  the  English  common  law  the 
question  is  always  one  of  fact,  depending  upon  the  evi- 
dence. 

Obstetricians  have  furnished  us  with  numerous  in- 
stances of  utero-gestation  extending  beyond  the  40th 
week,  as  calculated  from  the  cessation  of  the  catamenia. 
Dr.  Ogston  has  tabulated  155  such  cases,  of  which  — 

55  were  protracted  to   the  41st  week  or  to  287  days. 


42 
30 
13 
12 
3 


42d 

43d 

44th 

45th 

47th 


294  " 
301  " 
308  " 
315  " 
322-325  " 


He  also  tabulates  55  cases  dating  from  a  single  coitus, 
as  follows :  — 


200 


MEDICAL  JURISPRUDENCE. 


2  cases  protracted  to  281  days,  or  40  weeks,  1  day. 


2 

283 

40 

3 

2 

284 

40 

4 

2 

286 

40 

6 

4 

287 

41 

1 

288 

41 

1 

1 

289 

41 

2 

1 

291 

41 

4 

3 

« 

293 

41 

6 

or  8  were  protracted  into  the  41st  week,  7  into  the  42d, 
while  3  had  almost  reached  the  43d  week.  From  these 
cases  he  arrives  at  the  conclusion  that  utero-gestation 
may  in  a  few  instances  be  extended  to  the  44th  or  even 
to  the  46th  week. 

Upon  the  same  subject  Dr.  Tidy  concludes  that  there 
is  considerable  evidence  to  show  that  41,  42,  and  43 
weeks  may  elapse  between  coitus  and  labor ;  and  that 
although  it  is  impossible  to  state  that  44  weeks  or  even 
longer  periods  of  gestation  may  not  occur,  it  must  be 
conceded  that  there  are  no  well-recorded  cases  of  such 
protraction,  except  where  the  time  has  been  determined 
by  the  cessation  of  the  catamenia. 

In  cases  of  this  sort,  moral  considerations,  such  as  the 
character  of  the  parents,  probability  or  possibility  of 
access,  are  matters  of  great  importance. 

In  cases  where  pregnancy  is  much  prolonged  beyond 
the  usual  period,  as  well  as  in  doubtful  cases,  the  possi- 
bility of  the  more  or  less  complete  development  of  the 
ovum  in  the  ovary,  in  the  Fallopian  tube,  in  the  walls  of 
the  uterus,  or  in  the  peritoneal  cavity,  must  not  be  lost 
sight  of.  In  the  peritoneal  cavity  the  ovum  may  proceed 
full  development,  become  encysted,  and  remain  dormant 
for  years  ;  but  in  the  other  cases  mentioned,  pregnancy 


LEGITIMACY  AND  PATERNITY.  201 

will  not  be  likely  to  proceed  farther  than  the  first  half  of 
the  usual  term  without  causing  the  death  either  of  the 
foetus  or  of  the  mother. 

In  this  connection,  the  possibility  of  super-foetation 
or  the  impregnation  of  a  second  ovurn  in  a  woman  al- 
ready pregnant,  should  not  be  lost  sight  of.  Many  of  the 
supposed  cases  of  super-foetation  may  doubtless  be  ex- 
plained as  being  twin  or  triplet  births,  where  a  considera- 
ble interval  has  elapsed  before  the  birth  of  each  child 
after  the  first.  A  case  of  triplets  is  recorded  where  there 
was  an  interval  of  fifteen  days  between  the  successive 
births.  It  should  also  be  remembered  that  there  are  in- 
stances of  foetuses  remaining  in  utero  for  a  considerable 
time  after  their  death,  even  when  there  is  no  other 
foetus  alive  in  the  womb;  and  that  at  the  fifth  and 
eighth  month  of  pregnancy  dead  foetuses  of  not  greater 
development  than  from  three  to  five  months  have  been 
born ;  and  that  not  unfrequently  dead  foetuses  of  dif- 
ferent degrees  of  development  have  been  retained  until 
the  expiration  of  full  term.  Excluding,  however,  all 
cases  which  are  liable  to  be  mistaken  as  cases  of  super- 
foetation,  there  are  a  few  cases  which  are  difficult  of  ex- 
planation on  any  other  hypothesis  than  that  a  second 
impregnation  must  have  taken  place  while  a  partially 
developed  foetus  was  in  the  womb. 

In  determining  whether  the  case  is  one  of  super-fceta- 
tion or  not,  the  following  points  should  be  investigated : 
the  size  and  development  of  each  child,  and  the  inter- 
val between  the  births.  If  the  children  are  both  mature, 
and  the  interval  between  the  births  is  two  months, 
super-foetation  is  probable,  since  it  is  altogether  improb- 
able that  a  seven  months'  child  should  possess  the 


202  MEDICAL  JURISPRUDENCE. 

appearances  of  maturity  of  a  nine  months'  child.  If  the 
interval  varies  between  two  and  three  months,  and  the 
first  child  is  immature  and  the  second  mature,  the  case 
is  more  likely  one  of  twins,  where  one  is  born  prema- 
turely and  the  other  at  full  term.  Where,  however, 
there  is  an  interval  of  four  months  between  the  births, 
and  both  children  are  capable  of  being  reared,  super- 
fcetation  may  be  admitted,  as  it  is  highly  improbable 
that  a  five  months'  child  should  be  capable  of  being 
reared. 

3.  Similarity,  or  likeness.  —  Most  authors  upon  medi- 
cal jurisprudence  regard  likeness  existing  between  the 
child  and  its  alleged  father,  as  strong  evidence  of  pater- 
nity ;  and  even  Lord  Mansfield  is  reported  to  have  said, 
"  I  have  always  considered  likeness  as  an  argument  of  a 
child  being  the  son  of  a  parent."  The  absence  of  like- 
ness is  certainly  not  evidence  of  non-relationship,  and 
there  is  great  difficulty  in  drawing  any  definite  conclu- 
sion from  mere  likeness.  It  has  been  definitely  held  in 
a  case  recently  decided  by  the  supreme  court  of  Wis- 
consin (Hanawalt  vs.  The  State,  64  Wis.  84),  that  in  a 
bastardy  case  the  child  may  not  be  exhibited  to  the  jury 
as  evidence  of  paternity. 

In  questions  of  this  sort  the  possibility  of  atavism, 
or  resemblance  of  a  child  to  some  ancestor  prior  to 
its  father  or  mother,  should  be  remembered ;  also  that 
in  cases  of  a  second  marriage  by  the  mother,  a  child  of 
the  second  marriage  may  resemble  neither  parent,  but 
the  first  husband. 

In  questions  of  paternity  considerable  importance  is 
properly  attached  to  the  transmission  of  color ;  and 
there  are  instances  where  the  paternity  of  the  father 


LEGITIMACY  AND  PATERNITY.  203 

who  was  a  black  man,  has  been  established  by  the  color 
of  the  child.  The  case  of  the  Commissioners  vs.  Whis- 
telo  (3  Wheeler  Crira.  Cases,  194)  is  an  interesting  case 
in  this  connection. 

4.  Supposititious  children.  —  Cases  of  pretended  de- 
livery or  alleged  substitution  of  one  child  for  another 
should  be  examined  by  the  medical  jurist  upon  the  prin- 
ciples stated  in  a  preceding  chapter.  Without  the  least 
delay,  careful  examination  of  the  person  of  the  woman 
should  be  made  in  order  to  ascertain  whether  there  are 
or  are  not  signs  of  recent  delivery.  A  demand  should  be 
made  to  see  the  placenta,  and  the  child  should  be  ex- 
amined with  reference  to  ascertaining  whether  its  ap- 
pearance agrees  with  that  of  the  alleged  mother.  Stains 
upon  the  bedding  and  marks  of  blood  may  be  fraudu- 
lently made ;  and  there  are  instances  of  the  substitution 
of  some  viscus  of  an  animal  for  the  placenta. 


CHAPTEE  XVI. 

PERSONAL  IDENTITY. 

General  Considerations. —  Questions  of  personal  iden- 
tity often  become  matters  of  inquiry  in  the  course  of 
judicial  proceedings.  Such  cases  will  usually  turn  upon 
the  evidence  of  ordinary  witnesses  without  the  aid  of 
the  medical  expert;  not  unfrequently,  however,  such 
expert  is  able  to  furnish  important  aid  in  determining 
such  questions. 

The  question  may  arise  in  the  case  of  a  living  person 
or  of  a  body  which  has  been  dead  only  a  short  time ; 
with  respect  to  bodies  long  dead  or  with  respect  to 
complete  skeletons  or  detached  portions  of  the  same. 
In  the  case  of  a  living  person  or  of  a  body  only  re- 
cently dead,  the  sex,  occupation,  complexion,  general 
type  of  face,  race,  hair,  nails,  stature,  scars,  injuries, 
congenital  malformations,  as  well  as  the  clothes,  etc., 
upon  the  body,  form  important  matters  for  investiga- 
tion. In  cases  where  the  remains  are  mutilated  or 
only  a  portion  of  the  body  is  discovered,  the  question 
usually  presents  more  difficulty.  The  case  of  The 
Commonwealth  vs.  Dr.  Webster,  for  the  murder  of  Dr. 
Parkman,  reported  in  5  Gush.  295,  386,  is  an  interesting 
one  in  this  connection.  See  also  Bemis's  report  of 
this  case.  In  such  cases  the  stature  may  often  be 


PERSONAL  IDENTITY.  205 

approximately  determined  from  the  measurement  of 
certain  bones  and  their  known  relation  to  the  height 
of  the  person.  The  correspondence  or  otherwise  of  the 
several  parts  will  sometimes  enable  one  to  determine 
the  question  whether  they  are  parts  of  the  same  body 
or  not.  The  method  of  mutilation  is  sometimes  sug- 
gestive. The  cause  of  the  death  may  in  some  in- 
stances be  determined  by  the  examination  of  mutilated 
remains. 

The  extent  of  the  destruction  of  the  soft  parts,  as 
bearing  upon  the  time  of  death,  is  often  important  to 
be  considered.  Clothes,  buttons,  jewelry,  or  other  arti- 
cles surrounding  the  body,  if  there  are  any,  should  be 
carefully  examined  and  preserved. 

Bodies  long  dead,  skeletons  and  detached  bones.  — 
The  length  of  time  required  in  an  ordinary  grave  to 
reduce  a  body  to  a  skeleton  is  supposed  to  be  about 
ten  years ;  certain  parts,  such  as  the  hair  and  nails,  will 
resist  decomposition  much  longer,  if  not  indefinitely. 
The  subject  of  decomposition  of  a  body  has,  however, 
been  fully  considered  in  another  place.  The  position 
and  relation  of  the  bodies  to  their  surroundings  may 
be  of  aid  in  determining  their  character  and  identity. 
In  Christian  burial  it  is  customary  to  place  the  body  at 
full  length  in  the  ground,  with  the  head  towards  the 
west.  Eemains  of  clothes,  buttons,  jewelry,  etc.,  as 
already  stated,  will  often  afford  valuable  aid  in  the 
identification  of  a  body.  Where  the  whole  skeleton  is 
submitted  for  examination  there  can  be  no  difficulty  in 
deciding  whether  the  bones  are  human  or  not;  and 
in  ordinary  cases  there  ought  not  to  be  much  difficulty 
in  determining  whether  single  bones  preserved  entire, 


206  MEDICAL  JURISPRUDENCE. 

are  or  are  not  human.  It  would  be  presumptuous, 
however,  in  most  instances  where  the  bones  are  not 
considered  human  to  undertake  to  determine  to  what 
animal  they  belong. 

By  the  aid  of  the  microscope  it  is  possible  to  determine 
whether  the  smallest  fragment  found  is  or  is  not  bone  ; 
but  according  to  the  present  state  of  our  knowledge 
it  is  not  possible  thus  to  determine  whether  a  particu- 
lar fragment  is  part  of  a  human  bone  or  of  some  other 
animal. 

It  sometimes  becomes  important  to  determine  whether 
bones  are  parts  of  the  same  skeleton  or  belong  to  more 
than  one  body ;  this  can  only  lie  determined  by  com- 
parison and  placing  each  bone  in  the  place  where  it 
belongs,  aided  by  a  competent  knowledge  of  human 
anatomy.  Where  the  bones  are  fractured  or  otherwise 
injured,  it  is  important  to  determine  whether  the  injury 
was  caused  during  the  exhumation  or  during  life  ;  and 
if  during  life,  whether  or  not  it  was  of  recent  occurrence. 
If  new  bone  is  found  around  the  broken  ends  this  is 
proof  that  the  fracture  occurred  some  time  before  death. 
Diseased  conditions  of  a  bone  may  be  discovered,  and 
in  such  case  should  carefully  be  distinguished  from 
decay  and  violence.  All  personal  deformities  should 
be  carefully  noticed.  The  presence  of  foetal  bones  about 
the  skeleton  of  a  female,  suggests  but  does  not  prove 
pregnancy. 

The  age  may  sometimes  be  approximately  deter- 
mined by  inspection  of  the  bones,  a  subject,  however, 
which  will  be  further  considered  in  the  next  section. 

Age. — The  determination  of  age  during  life  is  usually 
a  matter  of  considerable  difficulty.  In  the  case  of 


PERSONAL  IDENTITY.  207 

children  it  may  usually  be  determined  approximately 
by  observing  the  teeth,  height,  weight,  and  general 
development ;  in  cases  of  hereditary  syphilis  and 
other  diseased  conditions,  the  development  may  be 
retarded. 

During  the  middle  period  of  life  there  is  very  great 
difficulty,  if  not  an  impossibility  in  determining  the 
age ;  as  the  person  becomes  older  this  difficulty  dimin- 
ishes somewhat.  In  females  of  advancing  age  the 
mammae  either  waste  or  enlarge  considerably;  in  old 
people  the  arteries  often  become  cord-like  and  tortuous, 
and  the  arcus  senilis  appears  in  the  eye.  The  figure 
stoops  as  the  intervertebral  substance  is  absorbed,  and 
the  muscular  power  lessens;  the  teeth  decay  or  come 
out,  and  the  person  puts  on  the  characteristic  appear- 
ance of  senility,  which  being  familiar  to  every  one 
needs  no  further  description.  In  determining  age  from 
the  skeleton,  important  evidence  is  often  derived  from 
the  points  of  ossification  and  the  extent  to  which  os- 
seous union  has  progressed.  The  following  details 
under  this  head  are  taken  from  Dr.  Tidy's  work  on 
Legal  Medicine :  — 

1  year :  Points  of  Ossification,  —  lower  extremities  of  hu- 
merus  and  ulna ;  heads  of  the  femur  and  humerus ;  upper 
cartilage  of  tibia. 

1  £  years :  Anterior  fontanelles  should  be  closed. 

2  years :  Points  of  Ossification,  —  lower  cartilages  of  radius, 
tibia,  and  fibula. 

2£  years:  Points  of  Ossification, — greater  tuberosity  of 
the  head  of  the  humerus ;  patella ;  lower  ends  of  the  last 
four  metacarpal  bones. 

3  years :  Points  of  Ossification,  —  the  trochanters. 


208  MEDICAL  JURISPRUDENCE. 

4  years :  Points  of  Ossification,  —  the  second  and  third 
cuneiform  bones  of  the  tarsus. 

4 £  years :  Points  of  Ossification,  —  the  small  tuberosity  of 
the  head  of  the  humerus  ;  the  upper  cartilage  of  the  fibula. 

6  years :  The  descending  ramus  of  the  pubis  meets  the 
ascending  ramus  of  the  ischium. 

From  8  to  10  years :  The  upper  cartilage  of  the  radius 
becomes  ossified. 

9  years :   The   ilium,  ischium,  and   pubis  meet   in   the 
cotyloid  cavity  (acetabulum)  to  form  the  pelvis. 

10  years :  Ossification  begins  in  the  cartilaginous  end  of 
the  olecranon. 

12  years :  Points  of  Ossification,  — the  pisiform  bones  of 
the  carpus. 

13  years:  The  three  portions  of  the  os  innominata  (ilium, 
ischium,  and  pubis),  though  nearly  united,  can  still  be  sepa- 
rated.    The  neck  of  the  femur  is  ossified. 

14  years,  or  about  puberty :  There  are  now  added  some 
fourteen  additional  centres  to  the  sacrum. 

15  years :  The  coracoid  process  becomes   united  to   the 
scapula. 

Between  15  and  16  years:  The  olecranon  becomes  united 
to  the  ulna. 

From  18  to  20  years :  The  epiphysis  at  the  upper  end  of  the 
thigh  bone  is  joined  to  the  body  of  the  bone,  as  well  as  those 
belonging  to  the  metacarpus,  metatarsus,  and  phalanges. 

20  years :  The  upper  and  lower  epiphyses  of  the  fibula,  as 
well  as  the  lower  epiphysis  of  the  femur,  are  respectively 
united  to  the  bones. 

25  years :  The  epiphysis  of  the  sternal  end  of  the  clavicle, 
and  of  the  crista  ilii  are  united  to  the  bones. 

If  all  the  epiphyses  be  found  united  to  their  bones, 
and  the  bones  themselves  are  solid  and  well-marked  as 


PEESOXAL  IDENTITY.  209 

to  muscles,  processes,  and  foramina ;  and  further,  if  the 
jaws  show  the  wisdom  teeth,  —  we  may  conclude  the 
individual  to  be  of  adult  age. 

The  Vertebrae.  —  The  epiphyses  of  the  bodies  of  the 
vertebrae  are  sometimes  not  consolidated  until  thirty 
years  of  age. 

The  Cartilages  of  the  Larynx  in  advanced  life  assume 
more  the  appearance  of  osseous  than  of  cartilaginous 
structure. 

The  Sternum.  —  The  second  and  third  pieces  of  the 
sternum  rarely  join  until  the  thirty-fifth  or  fortieth 
year,  while  the  union  of  the  first  and  second  pieces  is 
not  usually  complete  until  quite  advanced  life. 

The  Cartilages  of  the  Ribs.  —  The  cartilages  of  the 
ribs  generally  ossify  late  in  life.  Dr.  Humphrey  regards 
this  ossification  as  rather  a  sign  of  disease  than  of  age. 
The  first  cartilage  is  more  frequently  ossified,  and  at  an 
earlier  period  of  life,  in  men  than  in  women. 

The  Skull.  —  In  old  age  the  diploe  is  more  or  less 
absorbed,  leaving  the  cranial  bones  thinner  than  they 
were  in  middle  life.  The  sutures  become  firmly  ossi- 
fied, and  gradually  less  distinct.  If  the  sutures  of  the 
skull  are  indistinct,  we  may  then  fix  the  age  as  at  least 
between  fifty  and  sixty.  As  a  rule  the  parietal  sutures 
disappear  about  the  age  of  puberty,  although  sometimes 
(but  rarely)  they  remain  separate  throughout  life. 

The  Lower  Jaw.  —  The  alveolar  cavities  containing 
the  teeth  are  formed  about  the  sixth  month  of  intra- 
uterine  life,  while  the  rudiments  of  the  whole  of  the 
temporary  and  of  some  of  the  permanent  teeth  (the 
anterior  molars,  for  instance)  are  usually  found  within 
the  gums  in  capsules  at  the  time  of  birth.  Again,  the 


210  MEDICAL  JURISPRUDENCE. 

jaw  of  the  infant  is  rounded  and  somewhat  semi-circu- 
lar, the  ramus  and  body  forming  an  obtuse  angle.  As 
age  advances  towards  middle  life,  the  jaw  loses  its 
roundness,  and  as  the  alveolar  processes  containing  the 
teeth  become  more  and  more  perfect,  exhibits  a  well- 
marked  angularity  and  squareness.  With  old  age,  the 
teeth  drop  out  or  decay  away,  the  jaw  returning  to  its 
infantile  shape.  After  a  time  the  whole  alveolar  body 
may  become  absorbed,  a  sharp  ridge  replacing  the  holes 
for  the  teeth  as  they  originally  existed. 

The  Femur.  —  The  neck  of  the  femur  before  puberty  is 
directed  obliquely,  so  as  to  form  a  gentle  curve  from 
the  axis  of  the  shaft.  In  the  adult  male  it  forms  an 
obtuse  angle  with  the  shaft,  being  directed  upwards, 
inwards,  and  a  little  forwards.  In  the  female  it  ap- 
proaches more  nearly  to  a  right  angle.  Occasionally 
in  very  old  subjects,  and  more  especially  in  those 
greatly  debilitated,  its  direction  becomes  horizontal,  so 
that  the  head  sinks  below  the  level  of  the  trochanter, 
and  the  length  diminishes  to  such  a  degree  that  the 
head  becomes  almost  continuous  with  the  shaft. 

The  subject  of  sex  has  already  been  considered  in 
another  chapter. 

Stature  and  Weight.  —  The  average  lengths  of  the 
foetus  at  different  periods  of  intra-uterine  life,  and  of 
children  and  adults  at  various  ages,  are  variously  statec1 
by  different  authors. 

The  following  table  is  taken  from  M.  Sue :  — 


PERSONAL  IDENTITY. 


211 


Age. 

Total  Length. 

Trunk. 

Upper 
Extremities. 

Lower 
Extremities. 

Foetus  of   ) 
6  weeks,  j 

16  lines. 

1  inch. 

5  lines. 

4  lines. 

2£  months. 

2  in.  3  lines. 

1  in.  8  lin. 

9  lines. 

7  lines. 

3 

3  inches. 

2  in.  1 

13  lines. 

11  lines. 

4 

4  inches  4£  lines. 

2  in.  11 

1  in.  9  lin. 

1  in.  5£  lines. 

5 

GJ  inches. 

4  in.  4 

2  in.  6  " 

2  in.  2 

6 

9  inches. 

5  in.  8 

3  in.  7   " 

3  in.  4       " 

7 

1  foot  some  lines. 

6  in.  5i 

5  in.  10  " 

5  in.  9 

8 

14  inches  9  lines. 

8  in.  3| 

6  in.  8  " 

6  in.  6       " 

9 

18  inches. 

10  inches. 

8  inches. 

8  inches. 

1  year. 

22-J-  inches. 

13  in.  6  lin. 

9  inches. 

9  inches. 

3  years. 

2ft.  9  in.  somelin. 

19  inches. 

14  inches. 

14  in.  some  lin. 

10    " 

3  feet  8|  inches. 

2  feet. 

19  inches. 

20  in.  6  lines. 

14    " 

1  feet  7  inches. 

2  feet  4  in. 

24  in.  6  lin. 

27  inches. 

25    " 

5  feet  4  inches. 

2  feet  8  in. 

30  inches. 

32  inches. 

Healthy  children  of  healthy  mothers,  as  a  rule,  di- 
minish considerably  in  weight  soon  after  birth,  such 
decrease  amounting  to  about  l-14th  of  the  total  weight 
at  birth.  In  about  60%,  children  begin  to  increase  in 
weight  about  the  fourth  day,  and  about  the  tenth  day 
the  weight  will  be  the  same  or  slightly  in  excess  of  that 
at  birth.  The  increase  in  a  child's  weight  thereafter 
should  be  progressive ;  much  depends,  however,  upon 
the  hygienic  conditions  surrounding  it  and  the  nature 
and  amount  of  its  food,  etc. 

The  following  table,  taken  from  Tidy,  gives  the  average 
monthly  weight  of  young  children  during  the  first  year : 


Ibs.    oz. 


At  birth 

6      8 

7  months 

1  month 

7      4 

8 

2  months 

8      4 

9 

3 

9      6 

10 

4 

10      8 

11 

5 

11       8 

12 

6        " 

12      4 

Ibs. 

13 
14 
15 
16 
17 
18 


212 


MEDICAL  JURISPRUDENCE. 


The  average  weight  of  male  adults  at  20  is  143 
pounds,  and  of  females,  120  pounds.  (See  post,  INSUR- 
ANCE.) As  a  rule,  women  increase  in  weight  up  to  nearly 
fifty ;  while  males  so  increase  only  up  to  thirty-five ;  in 
advanced  age  both  sexes  weigh  about  fifteen  times  their 
weight  at  birth. 

The  following  table,  from  Barthes  &  Rilliet,  is  founded 
on  the  measurements  of  thirty-seven  well-nourished  and 
well-grown  children :  — 


3J  to  6  years. 

6  to  10  years. 

11  to  15  years. 

Height  

Inches. 
32.8-38 

Inches. 
38-50.8 

Inches. 

50-62.8 

Length  of  Sternum      .... 
Length  of  Dorsal  Vertebrae 

Space  between   the   Coracoid 
processes   

4.4-5.2 
6.6-8.8 

6.2-6.8 

4.8-6 
7.2-10.4 

6-8 

6-7.2 
9.2-11.6 

7.6-10.8 

Round     the     Thorax     (under 
Armpits)  during  inspiration 
while  seated       

20.4-24.4 

22.4-26.8 

27.6-35.2 

Round  the  Thorax  (under  Nip- 
ples) during  inspiration  .     . 

22-25 

22.4-26.8 

27.2-32 

The  average  height  of  the  adult  French  male  is  said 
to  be  63  inches,  and  of  the  adult  French  woman,  about 
five  feet.  In  England  the  average  height  of  men  born 
under  favorable  circumstances,  is  said  by  Dr.  Tidy  to 
be  5  feet,  9  3-5  inches,  and  of  women,  5  feet,  2  inches. 
The  head  is  £  part  of  the  total  height,  and  is  divided 
into  two  equal  parts  immediately  below  the  eyes,  the 
nostrils  being  midway  between  the  eyes  and  chin.  The 
pubis  is  the  central  point  between  the  two  extremities 


PERSONAL  IDENTITY.  213 

of  the  body.  When  the  arms  are  raised  vertically  above 
the  head,  the  navel  is  the  centre  of  the  length ;  if  the 
arm  is  divided  into  five  parts,  the  hand  occupies  one 
part  and  the  fore-arm  and  arm  two  parts  each  ;  multi- 
ply, therefore,  the  length  of  the  hand  by  five  and  we  get 
the  length  of  the  arm.  The  carpal  and  metacarpal  bones 
represent  half  the  length  of  the  hand ;  the  first  pha- 
lanx of  the  middle  finger  is  \  the  length  of  the  entire 
hand,  its  last  two  phalanges  being  together  equal  to  the 
length  of  the  first ;  the  last  phalanx  is  halved  by  the 
nail.  The  sole  of  the  foot  is  ^  longer  than  the  palm  of 
the  hand,  but  the  back  of  the  foot  or  instep  is  as  nearly 
as  possible  the  same  length. 

According  to  Dr.  Sieveking,  the  weight  should  be  in 
the  following  proportion  to  the  height : — 

Model  Heights  and  Weights. 

The  Height  being  The  Weight  should  be 

5  feet  1  inch  8  stone  4  Ibs. 

5  "  2  "  9  "  0  " 

5  "  3  "  9  "  7  " 

5  "  4  "  9  "  13  " 

5  "  5  "  10  "  2  " 

5  "  6  "  10  "  5  " 

5  "  7  "  10  "  8  " 

5  "  8  "  11  "  1  " 

5  "  9  "  11  "  8  " 

5  "  10  "  12  "  1  " 

5  "  11  "  12  "  6  " 

6  "  0  "  12  "  10  " 


As  to  this  point,  see  post,  INSURANCE. 


214 


MEDICAL  JURISPRUDEISCE. 


As  respects  the  dimensions  of  the  skeleton  at  various 
ages,  the  following  tables  by  Dr.  Humphrey  are  here 
given :  — 

Measurements  at  different  Ages  in  Incites. 


8 

Pelvis. 

a 

4 

Ik 

Age. 

^ 

•s  j= 

a 

at 

i.2 

EX) 

i 

3«2 

9 

a 

_S 

TJ 

a 

.3 

^ 

B  S 

*5 

* 

•a 

u  c 

a 

ec 

a 

s 

.0 

§ 

e^ 

c  S 

a 

oa 

b 

B 

i 

B 

CM 

H 

ta. 

HO 

•<& 

At  Birth  .... 

19 

7.0 

15.0 

3.5 

2.5 

3.1 

4.3 

3.5 

3.5 

1.3 

1.3 

2  years  (average)    . 

27 

8.6 

17.7 

47 

8.6 

3.1 

6.2 

6.1 

3.6 

2.2 

2.2 

4  to  6  years  (average) 

35 

11.8 

18.0 

6.6 

4.8 

4.1 

9.1 

7.1 

6.1 

2.5 

2.5 

8  to  12  years  (average) 

43 

12.8 

18.8 

8.3 

6.0 

6.1 

11.4 

9.4 

6.4 

3.1 

8.1 

g      (  Female      . 

55 

17.0 

19.0 

10.3 

7.0 

5.8 

14.8 

11.0 

7.8 

4.0 

8.6 

~.      !  Male     .     . 

54 

16.5 

19.0 

10.5 

7.5 

5.6 

15.0 

11.5 

J2      (  Average    . 

54 

16.6 

19.0 

10.4 

7.4 

67 

148 

11.3 

8.6 

3.8 

8.6 

as  x  (  Female 

59 

19.0 

19.5 

11.0 

8.2 

6.5 

160 

128 

8.0 

5.0 

4.8 

3  g  )  Male     •     • 

59 

17.5 

20.4 

110 

8.5 

6.3 

15.0 

13.0 

8.0 

39 

3.8 

ri  ;»,  (  Average    . 

60 

18.5 

19.8 

11.0 

8.4 

6.4 

15.8 

13.3 

8.0 

4.7 

4.5 

Average  Measurement  at  different  Ages,  reduced  to  a  Scale  q/"100. 


Age. 

«J 

— 

60 

'3 

I 

a 

00 

Circumference 
of  Skull. 

Ilumerus. 

a 

•a 

a 
a 

Femur. 

i 

H 

18.50 

18.88 
20.23 
21.86 
21.48 
22.16 

22.15 

1 

Pelvis. 

Transverse 
Diameter  of 

Antero- 
postcrior. 

nirfh      .     . 
2  Years  .     . 
4  to  6  years          . 
8  to  12  years 
15  years 
18  to  19  years 

Adult     .... 

100.0 
100.0 
100.0 
100.0 
100.0 
100.0 

100.0 

36.84 
31.40 

as.ii 

29.76 
30.74 
30.83 

34.15 

79.00 
65.55 
51.42 
43.72 
3570 
33.00 

31.54 

18.50 
17.40 
18.85 
19.30 
19.25 
19.00 

19.54 

13.20 

13.33 
13.71 

14.09 
13.70 
14.33 

1415 

1630 
11.48 
11.71 
11.86 
10.55 
11.11 

11.23 

22.60 
22.114 
26.00 
26.61 
27.40 
26.33 

2751 

18.50 
13.33 
14.57 
14.65 
14.81 
1383 

1603 

6.80 
8.14 
7.14 
7.21 
7.03 
7.83 

8.00 

6.80 
8.14 
714 
7.21 
6.66 
7.50 

6.61 

Orfila's  tables  differ  considerably  from  those  of  Dr. 
Humphrey ;  they  are  as  follows  :  — 


PERSONAL  IDENTITY. 


215 


TABLE  I. 

(Orfila's  First  Table.)     Stature  Calculated  from  length  of  Bones. 
[The  Measurements  are  given  in  Inches  and  Fractions  of  an  Inch.] 


Length  of  Bone. 

Stature. 

Humerus  (19  obs.)    .    . 
Ulna           14    " 
Femur        12    "        .     . 
Tibia          11    " 

Inches. 

Maximum. 

Minimum. 

Difference. 

14.50 
10.66 
17.75 
14.21 

68-10 
70-80 
69-66 
69.66 

64.50 
65.66 
64.50 
64.50 

3.60 
5-14 
5.16 
516 

TABLE  II. 
(Orfila's  Second  Table.)     Stature  Calculated  from  length  of  Bones. 


Length  of  Bone. 

Stature. 

Humerus  (6  obs.)      .     . 
Ulna           7    " 
Femur        7    "         .     . 
Tibia          7    " 

Inches. 

Maximum. 

Minimum. 

Difference. 

1300 
10.66 
18.10 
15.00 

73.25 
73.25 
72.00 
70.50 

69.75 
65.00 
67.00 
65.00 

3.50 
8.25 
5.00 
5.50 

The  differences  between  these  two  tables  show  that 
too  much  reliance  should  not  be  placed  on  calculations 
based  upon  the  relative  length  of  bones.  In  such  cal- 
culations it  may  be  added  that  it  is  usual  to  add  from  1 
inch  to  li  inches  for  the  soft  parts. 

Race. — Differences  of  race  are  chiefly  manifested  in  the 
skull,  which  Dr.  Tidy  divides  into  three  classes  :  — 


216  MEDICAL  JURISPRUDENCE. 

1.  The  prognathous  skull  of  the  negro,  iu  which  there 
is  a  forward  prolongation  of  the  jaw,  with  the  foramen 
magnum  placed  far  back. 

2.  The  pyramidal  skull  of  the  Esquimaux  and  of  the 
inhabitants  of  North  and  Central  Asia,  in  which  there  is 
a  peculiar  lateral  projection  of  the  zygoma,  due  to  the 
form  of  the  malar  bones,  rendering  the  skull  lozenge- 
shaped  in  appearance. 

3.  The  oval  or  elliptical  skull  of  the  Indo-European 
or  Caucasian,  which  he  regards  as  essentially  symmet- 
rical, having  no  marked  prominences  and   no    undue 
compressions. 

The  shape  of  the  skull  in  some  savage  or  half-civi- 
lized races  is  modified  by  artificial  pressure  upon  the 
head  during  infancy ;  but  it  is  apprehended  that  ques- 
tions relating  to  such  skulls  will  rarely  if  ever  be  sub- 
mitted to  a  medical  jurist,  and  definite  conclusions  as  to 
race  from  the  shape  of  the  skull  can  rarely  be  formed. 

The  capacity  of  the  skull,  according  to  the  better 
opinion,  seems  to  vary  in  different  races ;  but  for  details 
upon  this  subject  as  well  as  measurements  of  human 
skeletons  in  different  races,  the  student  must  be  referred 
to  more  voluminous  treatises. 

Definite  conclusions  as  to  race  can  rarely  be  drawn 
from  other  anatomical  peculiarities,  if  we  except  the 
color  of  the  skin  of  the  negro  and  of  other  dark  races, 
and  the  various  modifications  of  the  hair.  In  the  negro, 
however,  the  feet  are  wide  apart  and  flat,  and  the  os 
calcis  has  a  remarkable  backward  projection. 

Likeness.  —  This  subject,  so  far  as  it  relates  to  ques- 
tions of  legitimacy  and  paternity,  has  been  already 
considered. 


PERSONAL  IDENTITY.  217 

The  determination  of  questions  of  identity  of  living 
persons  by  likeness  will  usually  depend  upon  the  appli- 
cation of  the  ordinary  rules  of  evidence,  in  which  the 
medical  jurist  has  no  special  interest.  The  famous 
Tichborne  case  is  an  interesting  case  in  this  connection. 

Congenital  Peculiarities  and  Hereditary  Diseases.  — 
Congenital  peculiarities  and  hereditary  diseases  often  fur- 
nish strong  evidence  upon  the  issue  of  identity.  Moles, 
polydactylism,  hypospadias,  and  epispadias  are  not  un- 
frequently  transmitted  through  several  generations. 

Ncevi  may  often  furnish  evidence  of  identity.  He- 
reditary diseases,  such  as  syphilis,  etc.,  may  have  some 
bearing  upon  the  question  of  identity,  as  may  also  other 
congenital  peculiarities  and  diseases,  which  will  readily 
suggest  themselves  to  the  medical  jurist. 

Cicatrices  and  Tattoo  Marks.  —  Cicatrices  and  tattoo 
marks  are  often  important  to  be  considered  in  this  con- 
nection. A  scar  may  often  be  made  more  conspicuous 
by  briskly  rubbing  it  with  the  hand,  when  the  whiteness 
of  the  scar,  due  to  its  deficient  blood  supply,  will  ren- 
der it  conspicuous  in  comparison  with  the  sound  skin. 
As  respects  the  necessity  of  a  scar  following  a  wound, 
it  may  be  said  that  a  scar  always  results  from  a  wound 
involving  loss  of  substance ;  scars  may  not  result  from 
slight  punctures  where  the  surface  of  the  skin  has  only 
been  pierced,  as  by  the  prick  of  a  lancet  or  the  bite  of 
a  leech.  And  again,  where  the  scar  arises  from  a  clean 
cut  with  a  sharp  instrument,  especially  if  in  the  direc- 
tion of  the  muscular  fibres,  it  may  be  so  slight  and  nar- 
row as  to  escape  notice  even  on  a  careful  examination. 
It  should  be  remembered  that  a  scar  may  affect  the 
epidermis  only  and  not  the  cutis  vera ;  so  that  where 


218  MEDICAL  JURISPRUDENCE. 

putrefaction  has  set  iii  and  the  skin  has  commenced 
to  peel,  it  would  be  impossible  to  say  that  no  scar 
existed  during  life. 

As  respects  the  period  of  cicatrization  of  a  wound,  it 
may  be  stated  that  in  the  case  of  simple  incised  wounds  in 
tissues  of  average  vitality,  cicatrization  may  occur  in  from 
14  to  20  days.  The  rapidity  of  the  process  is,  however, 
dependent  upon  many  circumstances,  such  as  the  extent 
of  the  wound  (the  more  extensive,  the  less  rapid  will  be 
the  cicatrization),  its  nature,  whether  contused  or  lacer- 
ated (in  which  case  cicatrization  will  be  delayed),  its 
position  (wounds  of  the  lower  extremities  healing  more 
slowly  than  of  the  upper  extremities),  the  age  and  health 
of  the  person,  and  method  of  treatment. 

A  recent  cicatrix  is  soft,  tender,  and  pink,  or  at  any 
rate  redder  than  the  surrounding  skin  ;  in  the  course  of 
one  or  two  or  more  months,  the  cicatrix  becomes  less 
tender,  harder,  and  of  a  brownish-white  color.  As  its 
age  increases,  it  becomes  less  and  less  sensitive,  hard  and 
thick,  white  and  shining ;  when  a  scar  has  assumed  this 
appearance  it  is  impossible  to  determine  the  time  when 
the.  wound  was  inflicted,  except  that  it  may  be  safely 
said  that  it  did  not  result  from  a  wound  inflicted  two, 
three,  or  even  four  weeks  previously.  Where  the  cica- 
trix is  soft,  red,  and  tender,  the  probabilities  are  that  it 
is  not  of  long  standing. 

As  to  the  inference  which  may  be  drawn  from  the 
character  of  the  cicatrix  it  may  be  stated,  generally,  that 
the  cicatrix  of  a  straight  incised  wound,  involving  no 
loss  of  tissue,  is  usually  rectilinear ;  the  cicatrix  of  an 
oblique  wound  is  usually  more  or  less  semiltmar.  In- 
cised wounds  involving  loss  of  substance,  or  contused 


PERSONAL  IDENTITY.  219 

or  lacerated  wounds,  usually  produce  cicatrices  irregu- 
lar in  outline,  with  the  surface  depressed  and  more  or 
less  uneven  and  puckered ;  the  cicatrix  of  a  stab  is 
usually  triangular;  the  cicatrix  of  a  bullet-wound, 
where  the  weapon  was  fired  near  the  body,  is  large,  deep, 
and  irregular,  and  the  probabilities  are  that  tattoo  marks, 
due  to  particles  of  gunpowder  being  driven  under  the 
skin,  will  be  found  in  the  surrounding  tissue.  Where 
the  weapon  was  fired  from  a  distance  the  cicatrix  is 
usually  a  depressed  disc,  regular  in  shape  and  smaller 
than  the  ball  that  caused  it.  The  cicatrix  of  the  wound 
of  exit,  if  there  is  one,  will  usually  be  larger  and  more 
irregular  than  the  wound  of  entrance.  The  cicatrix  of 
a  burn  will  vary  somewhat  with  the  form  of  the  heated 
body  applied,  while  the  regularity  and  contraction  of 
the  scar  will  depend  upon  the  extent  and  depth  of  the 
burn. 

Cicatrices  produced  by  caustics  have  usually  regular 
edges ;  but  this  will  vary,  as  in  the  case  of  burns,  to  an 
unlimited  degree  ;  much  will  depend  on  the  caustic  used 
and  the  mode  of  its  application.  Scars  from  flogging 
usually  appear  as  faint  white  lines  extending  between 
little  circular  pits  marking  the  position  of  the  knots  of 
the  lash.  Scars  resulting  from  bleeding  are  white  and 
linear  ;  and  where  the  operation  has  been  properly  per- 
formed the  scar  is  oblique  with  reference  to  the  direc- 
tion of  the  vein.  Marks  of  cupping  usually  present 
themselves  as  a  series  of  small  white  symmetrical  cica- 
trices. The  cicatrix  of  an  issue  is  single,  rounded,  and 
depressed ;  that  of  a  seton  is  double,  each  mark  being 
linear  with  a  band  of  lymph  connecting  the  two  lines. 
Blisters,  as  a  rule,  leave  no  scar ;  occasionally,  however, 


220  MEDICAL  JURISPRUDENCE. 

where  suppuration  results,  scars  do  occur,  the  extent  of 
which  depends  on  the  amount  of  destruction  of  the 
parts  to  which  they  are  applied.  The  cicatrix  of  vac- 
cination is  an  irregular,  flat,  slightly  depressed,  honey- 
combed scar.  Small-pox  scars  are  deep  and  irregular, 
occupying  a  place  much  below  the  level  of  the  skin. 
The  cicatrix  of  a  syphilitic  abscess,  on  account  of  the 
great  loss  of  substance,  is  usually  very  deep.  Scrofu- 
lous ulcers  cause  irregular  and  deeply  furrowed  scars, 
with  hard,  uneven  edges.  The  character  of  the  cica- 
trices of  different  ulcers  will  depend  much  on  their 
locality  and  the  character  of  the  tissue  involved. 

The  locality  of  a  scar  will  often  afford  important 
evidence  as  to  its  character.  The  cicatrix  of  a  wound 
in  the  case  of  an  adult  who  has  ceased  growing  will 
be  smaller  than  the  wound  causing  it,  and  as  its  age 
increases  will  diminish  in  size  and  become  thicker  and 
whiter ;  but  in  the  case  of  a  child,  on  the  other  hand, 
a  cicatrix  will  increase  in  size  with  the  growth  of  the 
body ;  cases  are  recorded  where  the  length  and  breadth 
of  a  scar  have  thus  become  doubled. 

As  to  whether  a  cicatrix  can  be  obliterated  either  by 
lapse  of  time  or  by  artificial  means,  it  appears  to  be 
established  that  scars  resulting  from  slight  incised  or 
punctured  wounds  where  the  epidermis  only  has  been 
injured,  or  where  if  the  cutis  has  been  penetrated  there 
has  been  no  loss  of  substance,  may  in  time  disappear ; 
this  is  not,  however,  either  necessarily  nor  invariably 
the  case.  Marks  of  bleeding  may  become  obliterated 
after  the  lapse  of  two  or  three  years  ;  but  on  the  other 
hand,  there  are  recorded  cases  where  the  scars  were 
distinct  after  periods  of  twenty-six,  thirty,  fifty,  or  even 


PERSONAL  IDENTITY.  221 

nearly  sixty  years.  Where,  however,  a  scar  results 
from  a  skin  disease  or  from  a  wound  involving  loss  of 
substance,  it  is  exceedingly  doubtful  whether  the  scar 
can  ever  be  obliterated,  although  changes  may  occur 
resulting  in  its  becoming  less  distinct. 

Tattooing  consists  in  first  pricking  the  skin  deeply, 
and  then  rubbing  into  the  punctures  some  coloring 
substance.  The  process  causes  considerable  inflamma- 
tion, lasting  commonly  two  weeks  or  more.  In  about 
six  weeks  the  cuticle  scales  off,  and  at  the  end  of  about 
two  months  the  skin  assumes  its  normal  character, 
marked  with  the  device  pricked  in  by  the  operator. 
Tattoo  marks  of  irregular  outline  may  be  accidentally 
caused  by  coloring  matters,  such  as  coal-dust,  etc.,  find- 
ing their  way  into  a  wound.  Tattoo  marks  consisting 
of  scattered  dots  of  bluish  color  are  of  constant  occur- 
rence in  gun-shot  wounds  where  the  weapon  has  been 
fired  very  near  the  person. 

As  to  the  durability  of  tattoo  marks  it  seems  estab- 
lished that  they  may  entirely  disappear  in  a  small 
proportion  of  cases ;  ten  years  appears  to  be  the  mini- 
mum period  of  such  disappearance. 

The  permanence  of  tattoo  marks  depends  upon, 
first,  the  nature  of  the  coloring-matter;  and  second, 
the  efficiency  of  the  operation. 

1.  As  to  the  coloring-matter, — vermilion,  indigo,  and 
Prussian  blue  are  the  colors  most  disposed  to  fade. 
Cinnabar  and  common  ink  are  next  in  permanence  ; 
while  cobalt  and  ultra-marine,  and  especially  all  car- 
bonaceous material,  such  as  India  and  China  inks,  soot, 
coal-dust,  and  gunpowder,  all  of  which  produce  a  bluish 
black  tattoo,  are  by  far  the  most  permanent.  The  color- 


222  MEDICAL  JURISPRUDENCE. 

ing-matter  used  in  tattooing,  even  after  its  natural 
obliteration,  may  frequently  be  distinguished  in  the 
contiguous  absorbent  glands. 

According  to  Dr.  Tidy,  the  color  produced  by  taking 
nitrate  of  silver  is  absolutely  indelible. 

2.  As  to  the  efficiency  of  the  operation, — if  the  surface 
of  the  cutis  merely  be  penetrated  the  marks  are  very 
much  more  likely  to  fade  than  if  the  punctures  are 
carried  into  the  substance  of  the  skin.  Tattoo  marks 
are  more  likely  to  disappear  from  a  thin-skinned  person 
than  from  a  thick-skinned  one.  If  the  operation  is  well 
performed,  a  tattooed  skin  may  after  death  be  macerated 
in  water  for  an  indefinite  time  without  affecting  such 
marks.  The  separation  of  the  cuticle  by  putrefaction 
does  not  interfere  with  an  efficient  tattoo. 

Tattoo  marks  can  be  obliterated  by  artificial  means ; 
but  such  means,  resulting  in  suppuration  and  the  de- 
struction of  the  skin,  will  leave  scars  in  the  place  of 
the  tattoo,  as  a  general  rule. 

Marks  of  the  Hands  and  Feet.  —  Evidence  as  to 
footprints  and  hand-marks  is  usually  given  by  ordi- 
nary witnesses ;  sometimes,  however  the  opinion  of  the 
medical  jurist  may  be  required  upon  this  subject.  It 
appears  to  be  settled  as  respects  footprints  that  the 
prevailing  opinion,  that  the  impression  of  the  foot  upon 
the  soil  will  always  correspond  with  the  foot  making  it, 
is  by  no  means  correct ;  but  on  the  contrary  such  foot- 
prints may  be  either  larger  or  smaller  than  the  foot 
producing  them,  the  exact  relationship  and  size  depend- 
ing upon  several  causes. 

1.  The  material  in  which  the  footprint  occurs.  Where 
the  impression  occurs  in  sand  or  in  any  material  com- 


PERSONAL  IDENTITY.  223 

posed  of  minute,  freely  moving  particles,  the  footprint 
is  usually  smaller  than  the  foot ;  and  this,  in  the  case 
of  sand,  whether  it  is  dry  or  moist. 

On  the  other  hand,  if  the  impression  is  made  in  clay 
or  other  material  not  composed  of  fine  and  free  parti- 
cles, the  impression  is  invariably  larger  than  the  foot. 

2.  The   impression  will  depend  upon   the  shape   of 
the  boot  or  shoe  worn.     If  the  boot  or  shoe  worn  is  in 
any  respect  peculiar  as  respects  shape,  or  size,  or  nails 
on  its   lower  surface,  and  the  impression   corresponds 
thereto,  such  evidence  will   be  valuable ;   but   if  the 
correspondence  is  between  the  print  and  a  boot  not 
worn  at  the  time  the  impression  was  made,  it  is  of  little 
value. 

3.  The  size  of  the  impression  will  depend  upon  the 
rapidity  of  the  progression  and  the  level  of  the  ground. 
The  impression  produced  by  the  foot  of  a  person  when 
running  is  smaller  than  that  of  the  same  person  walk- 
ing ;  and  the  impression  of  the  same  person  standing 
will  be  still  larger.     In  a  slow  walk  an  impression  of 
the  whole  foot  or  the  greater  part  thereof  will  probably  be 
made,  while  in  running  the  mark  of  the  heel  will  be  less 
distinct,  and  that  of  the  front  of  the  foot  more  distinct 
than  in  walking.     In  going  up-hill  there  may  be  only 
slight  evidence  of  the  mark  of  the  heel,  while  the  mark 
of  the  ball  of  the  foot  may  be  very  distinct.     In  coming 
down-hill  the  impression  of  the  whole  foot,  but  espe- 
cially of  the  heel,  will  generally  be  well  defined. 

4.  The  character,  shape,  and  size  of  the  impression 
will  always  depend  to  a  great  extent  on  peculiarities 
of  gait;  such  peculiarities  should  in  each  case  be  care- 
fully studied. 


224  MEDICAL  JURISPRUDENCE. 

5.  Marks  of  blood  on  the  floor  of  a  room,  if  corres- 
ponding stains  be  found  on  the  sole  of  the  boot  worn  by 
the  prisoner,  may  furnish  important  evidence. 

Where  blood-stains  are  found  on  the  floor  or  other 
portions  of  the  room  it  is  better  to  remove  intact  the 
stained  portion  of  board,  plastering,  etc. 

6.  The  surroundings  of  all  footprints  should  be  care- 
fully examined.     In  some  cases  it  may  be  necessary  to 
take  a  cast  of  certain  footprints,  which  may  be  done  by 
raising  the  temperature  of  the  impressed  ground  to  about 
220°  F.  by  holding  over  it  a  warming-pan  filled  with  in- 
candescent charcoal,  and  then  dusting  over  it  powdered 
stearic  acid,  which  will  melt  and  soak  in,  taking  the 
exact  form  of  the  footprints.     This,  when  allowed  to 
cool,  may  be  detached  and  used  as  a  mould  for  the  pro- 
duction of  a  plaster-of-Paris  cast. 

In  a  recent  number  of  the  "Annales  d'Hygiene  et 
Me*decine  Le'gale  "  are  given  the  results  of  a  study  by 
Dr.  Masson  of  the  question  whether  certain  marks  were 
made  by  one  and  the  same  foot,  and  so  by  one  person 
only.  He  is  of  the  opinion  that  it  is  impossible  that 
two  human  footprints  should  closely  resemble  each  other 
unless  made  by  the  same  foot.  The  toes,  and  especially 
the  great  toe,  leave  marks  which  should  be  examined  at- 
tentively; these,  and  the  outline  of  the  digito-plantar 
depression,  the  line  which  defines  the  plantar  arch,  are 
the  data  for  diagnosis.  The  conclusions  drawn  by  Dr. 
Masson  are  — 

1.  The  dimension  and  shape  of  the  footprints  made 
by  the  same  foot  vary  with  the  attitude  taken.  2.  The 
two  extreme  and  characteristic  types  are  represented  by 
impressions  made  by  the  foot  in  walking  and  standing. 


PERSONAL  IDENTITY.  225 

3.  The  expert  called  to  study  the  matter  of  footprints 
should  always  take  impressions  of  the  foot  of  the  ac- 
cused, in  the  act  of  standing  and  of  walking,  and  should 
compare  only  those  which  correspond  with  the  same  at- 
titude. 4.  In  connection  with  the  measurements  made 
he  should  always  consider  the  points  which  throw  light 
upon  the  individual  characteristics  of  the  foot. 

The  Teeth.  —  The  condition  of  the  teeth  often  affords 
important  evidence  upon  the  question  of  identity.  The 
state  of  the  teeth,  and  especially  irregular  dentition, 
should  be  accurately  noted ;  and  in  important  cases  a 
cast  of  the  mouth  should  be  taken  by  a  dentist.  Hu- 
man beings  have  two  periods  of  dentition.  The  ar- 
rangement of  the  temporary  and  permanent  teeth  is 
given  in  Table  I. :  — 

TABLE  I. 
Arrangement  of  the  Temporary  and  Permanent  Teeth. 

e     I     2     I     a 

11211 

1     2  =  10  j 

20 


1      4      1      2  =  10) 
1      4      1      2  =  10) 


S3 

~    *       00  K 

|    g|    |       | 

si  u  M 

( Upper  Jaw  3     2  1  4     1 
Permanent  Teeth  < 

(Lower  Jaw  3     2  1  4      1     2      3 

The  periods  of  the  irruption  of  the  teeth  are  given  in 
Table  II.:  — 

15 


226  MEDICAL  JURISPRUDENCE. 

TABLE  II. 
The  Periods  of  the  Irruption  of  the  Teeth. 

(a)  Temporary  Teeth. 

6th  or  7th  month  ....  two  middle  incisors. 

9th      "  ....  two  lateral  incisors. 

12th      "  ....  first  molars. 

18th     "  ....  canines. 

24th     "  ....  two  last  molars. 

(b)  Permanent  Teeth. 

6th  or  7th  year the  four  anterior  or  first  molars. 

'  .....  two  middle  incisors. 

' two  lateral  incisors. 

'  first  bicuspids  or  prae-molars. 

'  second  bicuspids  or  prae-molars. 

' canines. 

1  second  molars. 

' last  molars,  or  "  wisdom  teeth." 

Iii  determining  the  age  from  the  state  of  the  teeth,  it 
should,  however,  be  born  in  mind  that  there  are  cases 
of  very  early  dentition ;  children  have  been  born  with 
teeth,  generally  the  central  incisors ;  other  cases  are 
recorded  where  dentition  was  preternaturally  late.  Dr. 
Tidy  records  the  case  of  a  woman  70  years  of  age  cut- 
ting a  canine  tooth,  and  there  are  cases  where  adults 
have  never  cut  their  teeth. 

The  development  of  the  teeth,  especially  the  first  set, 
may  be  retarded  by  rickets ;  syphilis,  on  the  other  hand, 
rather  hastens  the  irruption  of  the  teeth,  and  especially 
the  first  set,  and  may  cause  peculiarities  in  the  permanent 
teeth. 

Supernumerary  teeth,  and  third  dentition,  even,  have 
been  recorded. 

Hairs  and  Fibres. — The  microscopical  examination  of 
hairs  and  fibres  frequently  affords  important  evidence  of 


PERSONAL  IDENTITY.  227 

identity  in  criminal  cases.  Thus,  the  identity  of  hairs 
found  on  mutilated  portions  of  a  skull,  clutched  in  the 
hands  of  a  deceased  person,  on  the  clothes  of  the  ac- 
cused, or  imbedded  in  blood  on  a  weapon,  etc.,  with  the 
hair  of  the  deceased,  or  the  accused,  may  form  an  im- 
portant link  in  the  chain  of  evidence  to  convict  a  person 
accused  of  crime. 

In  cases  of  bestiality,  hairs  of  the  animal  will  almost 
always  be  found  adhering  to  the  clothes  of  the  person 
accused.  The  examination  of  the  hair  about  the  female 
genitals,  in  cases  of  alleged  rape,  may  reveal  the  exist- 
ence of  spermatozoa. 

Where  the  question  is  as  to  the  nature  of  the  hair, 
it  should  be  first  washed  in  water,  thoroughly  dried, 
then  soaked  in  turpentine  for  some  time,  and  afterwards 
mounted  in  Canada  balsam ;  it  should  then  be  examined 
with  a  medium  power  of  the  microscope,  the  power 
used  depending  somewhat  upon  the  nature  of  the  fibre. 
In  every  examination  of  fibres,  the  comparison  should 
be  a  direct  one  between  the  fibre  in  question  and  other 
fibres,  the  nature  of  which  is  positively  known.  It 
will  be  found  convenient  to  keep  a  series  of  hairs  of 
different  animals  and  of  different  fibres  permanently 
mounted  for  purposes  of  comparison.  The  observer 
should  make  himself  familiar  with  the  appearance  of 
all  ordinary  fibres,  such  as  cotton,  linen,  silk,  wool, 
hemp,  etc.,  and  the  effect  produced  upon  them  by  vari- 
ous reagents.  It  would  be  an  interesting  matter  to 
go  more  fully  into  the  examination  of  this  subject,  but 
want  of  space  forbids;  the  reader  is  referred  to  professed 
treatises  on  microscopy. 

As   respects   human   hair,  its   structure   and  devel- 


228  MEDICAL  JURISPRUDENCE. 

opment  will  be  found  treated  at  length  in  professed 
treatises  upon  anatomy,  histology,  and  physiology.  In 
this  connection  it  may  be  stated  that  hairs  are  appen- 
dages of  the  skin,  each  hair  being  imbedded  in  a  de- 
pression of  the  skin  called  a  "follicle,"  fixed  at  the 
bottom  thereof  by  dilatation  of  the  hair  itself  called 
the  "bulb."  The  portion  above  the  bulb  and  within  the 
follicle  is  called  the  "  root,"  and  the  portion  projecting 
beyond  the  surface,  the  "  shaft."  The  outer  or  cortical 
part  of  the  hair  is  shown,  when  treated  with  sulphuric 
acid,  to  be  composed  of  spindle-shaped,  flattened,  angu- 
lar cells  containing  pigment  granules  giving  the  color  of 
the  hair :  under  the  microscope  it  appears  to  be  tubular, 
although  it  is  not  in  fact  so.  The  inner  medullary  por- 
tion consists  of  granular,  nucleated  cells,  angular  or 
rounded  in  form,  arranged  linearly,  containing  air,  which 
causes  them  to  appear  black  by  transmitted,  and  white 
by  reflected  light.  The  whole  hair  is  surrounded  by  a 
cuticular  coat  of  flat  epithelial  scales ;  the  varieties  of 
arrangement  of  this  cuticular  layer  are,  in  great  meas- 
ure, the  cause  of  the  different  appearances  of  the  hair 
in  different  animals. 

The  following  table,  altered  by  Tidy  from  Dr.  Pfaffs 
work,  gives  the  diameters  of  hairs  from  different  parts 
of  the  body,  and  from  different  animals,  in  fractions  of 
an  English  inch :  — 

Fractions  of  Inch. 

Down  (lanugo)  from  a  suckling 

Down       "      from  a  young  girl's  arm      .     .     . 
Down      "      from  the  upper  lip  of  a  woman    . 

Down  of  beard  (iulus) 

Hair  from  a  woman's  head  (capillf)     .... 
Hair  from  female  pubes 


PERSONAL  IDENTITY.  229 

Fractions  of  Inch. 

Hair  from  a  man's  head  (capilli) ^-y 

Hair  from  axilla -j^j 

Hair  from  male  pubes -^-g- 

Hair  from  the  eyelashes  of  a  man   .     .     .    .     .  -$fa 

Eyebrows ^ 

Hair  from  nostrils   (vibrissce) ^g- 

Hair  from  moustache  (mystax) -%fa  to  yj-j 

Hair  from  the  ears  (tragi) -£%-% 

Hair  from  the  arm  of  a  man TWT  to  -^^ 

Hair  from  a  man's  hand 3^ 

Pig's  bristle ^ 

Hair  of  fallow  deer 5^5- 

Hair  of  horse -gfo 

Hair  of  goat jf, 

Hair  of  fox ^^ 

Hair  of  cow -$$-$ 

Hair  of  spaniel  dog TlW 

Hair  of  rabbit nVs 

The  characteristic  appearance  of  the  hairs  of  different 
animals  will  be  found  in  various  works  upon  microscopy, 
and  also  in  "  Woodman  and  Tidy's  Forensic  Medicine." 

The  question  whether  a  particular  specimen  of  hair 
is  human  or  not  is  ordinarily  not  difficult  of  answer. 
In  questions  as  to  the  nature  or  identity  of  hair,  the 
answer  should  always  be  based  upon  comparison  with 
authentic  specimens.  Microscopic  examinations  will 
frequently  enable  one  to  say  whether  the  hair  has  been 
lately  cut,  shaved,  or  violently  torn  from  the  body. 
Infant's  hair  which  has  never  been  cut  will  be  found 
to  taper  gradually  to  a  point ;  after  the  hair  has  been 
cut  the  ends  never  regain  this  taper  condition,  but  re- 
main more  or  less  rounded,  and  not  unfrequently  split, 
terminating  in  two  or  more  branches.  For  some  days 


230  MEDICAL  JURISPRUDENCE. 

after  cutting  the  hair  retains  a  certain  smoothness  of 
section.  Hairs  pulled  out  by  force  generally  appear 
crushed  and  somewhat  frayed;  the  sheath  will,  as  a 
rule  in  such  cases,  be  torn  away  with  the  bulb.  The 
condition  of  the  hair,  however,  lost  after  fevers  and 
other  acute  diseases,  closely  resembles,  as  regards  the 
condition  of  the  bulb,  a  sheath  thus  torn  out  violently. 
The  condition  of  the  hair  may  also  be  modified  by 
certain  skin  and  other  diseases. 

The  color  of  the  hair  may  be  changed  in  a  variety  of 
ways.  Light  or  red  hair  may  be  darkened  by  the  use  of 
dyes  containing  lead,  silver,  or  bismuth;  the  material 
in  such  cases  may  be  detected  by  chemical  analysis. 
Dark  hair  may  be  made  light  by  the  application  of 
chlorine  water,  which,  however,  is  apt  to  make  the  hair 
brittle  and  rotten.  A  golden  tint  may  be  produced  by 
the  use  of  peroxide  of  hydrogen. 

Where  the  color  has  been  changed  artificially,  it  will 
usually  be  marked  by  want  of  uniformity ;  and  if  the 
roots  of  the  hair  be  examined,  the  new  growth  will  be 
seen  to  be  of  a  different  color.  The  general  color  of  the 
hair  will  not  correspond  with  the  color  of  the  hair  on 
the  pubes  or  trunk.  Certain  diseases  will,  at  times,  effect 
a  great  change  in  the  color  of  the  hair ;  and  there  are 
authenticated  instances  of  its  sudden  change  without  an 
apparent  cause,  and  of  its  becoming  suddenly  bleached 
by  grief  or  fright,  although  the  last-mentioned  cases  do 
not  appear  to  be  so -well  authenticated. 

It  seems  to  be  settled  that  both  hair  and  nails  may 
grow  for  a  time  after  death,  owing  to  the  molecular  life 
of  the  epidermis  and  the  hair-follicles  continuing  for  a 
time  after  somatic  death. 


PERSONAL  IDENTITY. 


231 


Limits  of  Sight  and  Hearing.  —  Questions  of  identity 
sometimes  require  the  consideration  of  the  limits  of 
sight  and  hearing.  The  determination  of  such  questions 
may  be  modified  by  defects  of  vision,  such  as  hyperme- 
tropia,  or  long  sight ;  myopia,  or  near  sight ;  presbyopia, 
aged  sight ;  astigmatism  (due  to  the  axes  of  curvature  of 
the  cornea  being  unequal),  color-blindness,  and  the  like. 
A  limit  is  set  to  vision,  even  as  respects  lofty  objects, 
by  the  shape  of  the  earth.  The  following  table  shows 
the  distance  in  miles  of  the  farthest  visible  point  that 
can  be  seen  from  the  top  of  a  given  height,  taking  into 
account  the  effects  of  refraction  :  — 


Height 
in  Feet. 

Distance 
in  Miles. 

Height 
in  Feet. 

Distance 
in  Miles. 

Height 
in  Feet. 

Distance 
in  Miles. 

6 

2.96 

150 

16.2 

3,000 

72.0 

10 

4.18 

200 

18.7 

4,000 

83.0 

15 

5.12 

250 

20.9 

5,000 

94.0 

20 

5.91 

300 

22.9 

6,000 

102.0 

25 

6.61 

400 

26.4 

7,000 

110.0 

30 

7.25 

500 

29.5 

8,000 

118.0 

40 

8.37 

700 

30.5 

9,000 

125.0 

50 

9.35 

1,000 

41.8 

10,000 

132.0 

60 

10.25 

1,500 

51.0 

15,000 

162.0 

70 

11.1 

2,000 

59.0 

20,000 

187.0 

100 

13.2 

2,500 

66.0 

From  this  it  follows  that  a  man  of  ordinary  stature 
can  be  seen  on  a  clear  day  on  level  ground  at  a  distance 
of  3i  miles. 

As  respects  hypermetropia,  myopia,  etc.,  the  reader  is 
referred  for  information  to  professed  treatises  on  the 
eye. 

Color-blindness,  or  Daltonism,  in  which  red  and  green 
or  other  colors  cannot  be  distinguished,  has  doubtless 


232  MEDICAL  JURISPRUDENCE. 

been  the  cause  of  many  railway  accidents.  According 
to  statistics  furnished  by  Dr.  De  Fontenay,  from  the 
examination  of  9,659  persons  from  8  years  of  age  up- 
wards, 6,945  being  above  16  and  2,714  below  that  age, 
217,  or  2.25  per  cent,  were  color-blind.  Of  4,492  adult 
males,  165,  or  3.7  per  cent,  were  color-blind;  among 
these,  1,001  belonging  to  the  upper  classes  showed  a 
per  cent  of  3.09 ;  while  in  3,491  artisans,  laborers,  etc., 
the  per  cent  was  3.87.  Statistics  show  that  the  per  cent 
of  color-blindness  varies  greatly  with  the  employment, 
age,  and  sex.  Of  6,945  adults  above  the  age  of  16,  con- 
sisting of  4,492  males  and  2,453  females,  176,  or  2.56 
per  cent,  were  color-blind.  Among  the  females,  how- 
ever, there  were  only  11  cases  of  color-blindness,  or 
0.45  per  cent  Including  all  the  females  examined, 
amounting  to  3,819,  there  were  16  color-blind  persons, 
or  0.42  per  cent ;  while  of  5,840  males,  adults  and  chil- 
dren, there  were  201  cases  of  color-blindness,  or  3.44 
per  cent,  all  the  16  color-blind  females  belonging  to 
the  working  classes.  Among  2,714  children  from  8  to 
16  years  of  age,  41,  or  1.51  per  cent,  were  color-blind, — 
namely,  1,348  boys  with  36  color-blind,  or  2.67  per  cent ; 
and  1,366  girls  with  5  color-blind,  or  0.37  per  cent.  Ex- 
cluding two  cases  of  violet-blindness,  there  were  56  cases 
of  red-blindness,  24  of  green-blindness,  and  135  of  in- 
complete color-blindness.  In  all  the  cases  both  eyes 
were  examined  separately  and  found  to  be  affected. 

As  to  the  effects  of  age  on  acuteness  of  vision,  Dr.  De 
Gueret  finds  that  — 

The  acuteness  of  vision  at  50  years  has  diminished  | 
"  "  60  "  "        | 

«  «  70  c«  «        j 

"  "  80  "  "        4 


PERSONAL  IDENTITY.  233 

Moonlight,  Daylight,  Starlight,  etc.  —  The  light  of  the 
moon,  as  is  well  known,  varies  very  much ;  but  it  is 
stated  by  Dr.  Tidy  that  the  best  kuown  person  cannot 
be  recognized  by  the  clearest  moonlight  at  a  greater  dis- 
tance than  from  16  to  17  yards.  While  this  may  be 
true  as  respects  recognition  of  the  countenance,  it  would 
seem  that  if  there  were  anything  characteristic  about  the 
form,  dress,  gait,  etc.,  recognition  might  be  had  at  a 
greater  distance. 

By  starlight  only,  it  is  stated  by  the  same  author  that 
the  best  known  person  cannot  be  identified  further  off 
than  from  10  to  13  feet. 

Dr.  Montgomery  states  a  case  where  a  lady  was  ena- 
bled by  the  light  afforded  by  a  flash  of  lightning  to  see 
distinctly  and  afterwards  identify  a  man  robbing  her 
trunk  on  a  dark  night  in  the  cabin  of  a  vessel. 

As  to  the  light  afforded  by  the  flash  of  firearms, 
experiments  seem  to  negative  the  possibility  of  recogni- 
tion by  such  a  light ;  other  experiments  by  other  ob- 
servers seem  to  show  the  possibility  of  such  recognition. 
Very  much  would  depend  upon  the  nature  of  the  arm, 
ammunition,  the  relative  position  of  the  parties,  quan- 
tity of  smoke,  direction  of  the  wind,  etc.  Under  favor- 
able circumstances,  —  that  is,  with  a  bright  flash  at  a 
short  distance  on  a  dark  night,  and  in  the  absence  of 
artificial  light,  and  where  the  wind  is  such  that  the 
smoke  does  not  intervene,  —  it  would  seem  that  in  the 
majority  of  instances  recognition  is  possible. 

The  recognition  of  individuals  depends  upon  various 
points.  Where  the  person  is  comparatively  near,  feat- 
ures, color  and  arrangement  of  the  hair,  prognathism, 
color  of  the  eyes,  etc.,  are  the  principal  means  of  iden- 


234  MEDICAL  JURISPRUDENCE. 

tification.  Beyond  a  certain  distance,  stature,  gait,  gen- 
eral peculiarities,  etc.,  are  the  principal  means  of  identi- 
fication. De  Gue'ret  from  experiment  concludes  that  the 
best  known  persons,  even  those  possessing  well-marked 
personal  peculiarities,  can  be  recognized  only  with  diffi- 
culty, in  broad  daylight,  at  a  distance  of  100  metres, 
which  is  a  little  more  than  109  yards.  Beyond  150 
metres,  or  164  yards,  he  believes  recognition  to  be  im- 
possible. Less  known  and  less  remarkable  people  can 
be  recognized  in  broad  daylight  only  within  a  distance 
of  60  to  100  meters  (65  to  109  yards).  In  the  case  of 
people  who  have  no  personal  peculiarities  and  are 
almost  strangers,  he  regards  25  to  30  metres  (27  to  33 
yards)  as  about  the  limit  of  recognition.  Very  much 
would  depend,  however,  as  it  seems  to  us,  upon  the 
observer ;  for  it  is  a  well-known  fact  that  persons 
accustomed  to  using  their  eyes  at  long  distances  can 
recognize  persons  at  a  comparatively  great  distance. 

As  to  the  size  of  the  smallest  object  which  may  be 
seen  by  the  unassisted  sight,  there  is  considerable  differ- 
ence of  opinion.  Carpenter  states  that  the  smallest 
square  magnitude,  black  or  white,  that  can  be  seen  on 
the  ground  of  the  reverse  color,  is  about  ?^  or  -%fa  of 
an  inch;  while  particles  that  powerfully  reflect  light, 
such  as  gold  dust,  of  -3-^-5  of  an  inch,  can  be  seen  by  the 
naked  eye  by  common  daylight.  Dr.  Vincent  De  Gueret 
states  that  objects,  to  be  seen  at  all,  must  have  a  diameter 

of  irsW  of  an  inch- 

Lines  may  be  more  easily  seen  than  points;   thus, 

according  to  Dr.  Tidy,  opaque  threads  of  ^-§\nr  °f  an 
inch  can  be  seen  by  most  people  by  the  naked  eye 
when  held  towards  the  light.  Our  own  experience  is 


PERSONAL  IDENTITY.  235 

that  lines  ruled  on  glass  very  much  smaller  than  any  of 
the  above  may  be  distinctly  seen  under  favorable  cir- 
cumstances by  the  naked  eye.  In  our  judgment  it  would 
not  be  a  difficult  matter  to  see  a  line  1  mikron  (s^iyo 
of  an  inch)  in  breadth ;  and  Prof.  William  A.  Kogers 
states  that  he  and  Professor  Pickering  and  the  assistants 
at  Harvard  College  Observatory  have  with  the  naked 
eye  seen  lines  ruled  on  glass  which  could  not  have  been 
more  than  the  -j-giyVsTS"  °f  an  ^nc^  ^n  diameter. 

Passing  from  microscopic  objects,  Dr.  Tidy  states  that 
at  a  distance  of  one  foot  a  person  with  normal  sight  can 
scarcely  see  an  object  less  than  -£%  of  an  inch ;  and  that 
at  greater  distances  the  size  must  increase  proportion- 
ately. Our  own  experience  does  not  agree  with  this 
statement.  In  order  to  test  the  matter,  the  writer  sub- 
mitted the  following-described  test  to  19  different  per- 
sons of  ages  ranging  from  17  to  50  and  upwards.  The 
test  consisted  of  a  piece  of  black  paper  approximately 
one  millimetre,  or  -^  of  an  inch  square,  pasted  upon  a 
white  background ;  of  another  similar  white  square  upon 
a  black  background,  and  of  a  black  line  approximately 
one  millimetre,  or  ^V  °f  an  iQca  broad,  upon  a  white 
background.  The  cards  were  hung  in  a  good  light, 
not  artificial,  and  approached  from  such  a  distance  that 
they  were  invisible ;  and  the  distances  at  which  they 
became  visible  and  at  which  the  shape  of  the  squares 
could  first  be  defined  were  respectively  noted. 

The  mean  distance  at  which  the  black  square  upon 
the  white  background  became  visible  was  26  feet, 
4  inches ;  the  mean  distance  at  which  it  could  be  de- 
fined was  5  feet,  10  inches.  «The  mean  distance  at 
which  the  white  square  upon  the  black  background 


236  MEDICAL  JURISPRUDENCE. 

could  be  seen  was  22  feet,  11  inches ;  the  mean  dis- 
tance at  which  it  could  be  defined  was  5  feet,  7  inches. 
The  mean  distance  at  which  the  black  line  upon  a 
white  background  could  be  seen  was  75  feet.  The  last 
test  was  made  by  only  14  persons ;  all  the  rest  were 
made  by  19. 

Limits  of  Hearing.  —  The  velocity  of  sound  in  air 
at  32°  F.  or  zero  C.,  is  about  1,090  feet  per  second. 
This  velocity  may  be  considered  as  increasing  about 
two  feet  for  each  degree  of  Centigrade.  At  lower  tem- 
peratures the  velocity  is  less,  and  at  higher  temper- 
atures, greater.  In  water  the  velocity  of  sound  is  4 
times,  and  in  iron  17  times  greater  than  in  air.  The 
intensity  of  the  sound  in  free  air  diminishes  as  the 
square  of  the  distance  from  the  source  of  sound.  At 
great  elevations  the  loudness  of  the  sound  is  consider- 
ably diminished. 

With  the  normal  sense  of  hearing,  Savart  fixes  the 
limits  of  hearing  as  between  8  complete  vibrations  per 
second,  and  24,000,  while  Helmholtz  fixes  the  limit 
as  between  16  and  38,000,  or  11  octaves.  This  limit 
varies,  however,  in  different  people ;  and  practically,  no 
doubt,  will  be  found  to  be  considerably  less  than  the 
figures  above  stated.  The  distance  at  which  any  par- 
ticular sound  may  be  heard  in  free  air  varies  with  the 
circumstances  and  with  the  observer,  and  perhaps  can- 
not in  the  present  state  of  our  knowledge  be  definitely 
stated.  Incredible  as  it  may  seem,  the  writer  has  usu- 
ally been  able  to  hear  the  sound  of  the  impact  of  a 
rifle-ball  against  a  target  consisting  of  cloth  stretched 
upon  a  frame,  over  whicji  (the  cloth)  is  pasted  paper,  at 
a  distance  of  800  yards. 


PERSONAL  IDENTITY. 


237 


Limits  of  the  Sense  of  Smell.  —  The  limits  of  the 
sense  of  smell  will  not  often  come  in  question  in  a 
medico-legal  examination ;  still,  the  experiments  re- 
corded below,  made  by  Profs.  Edward  L.  Nichols  and 
E.  H.  S.  Bailey,  of  the  University  of  Kansas,  are  of 
such  interest  as  to  be  worthy  of  presentation  to  our 
readers.  The  following  substances  were  made  use  of: 
oil  of  cloves,  nitrite  of  amyl,  extract  of  garlic,  bromine, 
cyanide  of  potassium,  prussic  acid,  oil  of  lemon,  and  oil 
of  wintergreen.  A  series  of  solutions  of  each  was  pre- 
pared, such  that  each  member  was  of  half  the  strength 
of  the  preceding  one.  These  series  were  extended  by 
successive  dilutions  till  it  was  impossible  to  detect  the 
substances  by  smell.  The  order  of  the  bottles  contain- 
ing these  solutions  was  completely  disarranged,  and  the 
test  consisted  in  the  attempt  to  classify  them  properly 
by  the  unaided  sense  of  smell.  The  first  series  of  tests 
was  made  by  34  observers,  — 17  male  and  17  female; 
the  results  of  which  are  indicated  in  Table  I. 


TABLE  I. 

Amount  Detected. 


Oil  of 
Clores. 

Nitrite  of 
Amyl. 

Extract  of 
Garlic. 

Bromine. 

Cyanide  of 
Potassium 

Average  ) 
of  17 
males.    ) 

1  part  in 
88,218  of 
water. 

1  in  783,870 

1  in  57,927 

1  in  49,254 

1  in  109,140 

Average  ) 
of  17     > 
females.  ) 

1  part  in 
50,667  of 
water. 

1  in  311,330 

1  in  43,900 

1  in  16,244 

1  in  9,002 

238 


MEDICAL  JURISPRUDENCE. 


In  Table  II.  the  same  method  of  investigation  was 


followed  with  the  following  results :  — 


TABLE  IL 

Amount  Detected. 


Prussic  Acid. 

Oil  of  Lemon. 

Oil  of  Wintergreen. 

Average  of  27  ! 
males.  ) 

I  part'in  112,000 
of  water. 

1  part  in  280,000 
of  water. 

1  part  in  600,000 
of  water. 

Average  of  21  ) 
females.  j 

1  part  in  18,000 
of  water. 

1  part  in  116,000 
of  water. 

1  part  in  311,000 
of  water. 

Some  striking  individual  peculiarities  were  devel- 
oped in  the  course  of  these  experiments.  Three  of 
the  male  observers  could  detect  one  part  of  prussic  acid 
in  about  2,000,000  parts  of  water;  two  of  these  per- 
sons were  engaged  in  occupations  favoring  the  culti- 
vation of  this  sense.  Careful  chemical  tests  failed  to 
show  the  presence  of  prussic  acid  in  several  of  the  more 
dilute  solutions  in  which  it  could  be  detected  by  the 
sense  of  smell.  It  was  found  that  some  of  both  sexes 
could  not  detect  prussic  acid  even  in  solutions  of  almost 
overpowering  strength.  There  were  also  several  in- 
stances of  the  same  peculiarity  as  respects  bromine. 
As  will  be  seen  from  the  tables,  the  averages  show 
that  the  sense  of  smell  is  in  general  much  more  deli- 
cate in  the  case  of  male  than  of  female  observers. 

Stains. — The  identification  of  a  variety  of  stains, 
such  as  seminal  stains,  blood-stains,  etc.,  is  often  a  mat- 
ter of  great  importance  in  criminal  trials,  and  may 
conveniently  be  considered  in  this  place.  The  subject 


PERSONAL  IDENTITY.  239 

of  seminal  stains  has  been,  perhaps,  sufficiently  con- 
sidered in  another  chapter.  The  subject  of  blood-stains 
will  be  considered  in  this  place. 

In  examining  stains  suspected  to  be  blood,  their 
number,  size,  shape,  location  on  the  apartment,  gar- 
ment, or  instrument  submitted  for  examination,  should 
be  accurately  recorded.  Spots  of  blood  will,  as  a  rule, 
have  well-defined  and  somewhat  raised  edges ;  their 
color  will  depend  on  their  age  and  thickness,  the  mois- 
ture and  temperature  to  which  the  blood  has  been  sub- 
jected, and  the  nature  of  the  material  upon  which  it 
has  fallen.  There  are  three  sorts  of  tests  by  which  its 
nature  may  be  determined,  namely,  the  microscopic, 
chemical,  and  spectroscopic  tests. 

1.  Microscopic  Examination  of  Blood-stains.  —  The 
examination  of  a  spot  alleged  to  have  been  made  by  blood 
should,  in  our  judgment,  be  first  made  with  a  medium 
power  of  from  400  to  500  diameters,  for  the  purpose  of 
ascertaining  its  general  characteristics.  All  measure- 
ments of  blood-corpuscles  for  medico-legal  purposes, 
should  be  made  with  as  high  a  power  as  will  give  per- 
fect definition.  The  author  is  in  the  habit  of  using  a 
power  of  about  1,500  diameters,  and  is  of  the  opinion 
that  a  power  of  at  least  1,000  diameters  should  be  used 
for  such  purpose.  The  technique  of  such  examination 
cannot  be  entered  upon  in  detail  in  this  manual.  For 
extended  details  the  reader  is  referred  to  Woodman 
and  Tidy's  "  Legal  Medicine,"  Tidy's  "  Medical  Jurispru- 
dence," and  the  learned  and  interesting  discussions  of 
the  subject  by  Dr.  J.  J.  Woodard  and  Dr.  J.  G.  Eichard- 
son,  which  may  be  found  in  the  London  "Monthly 
Microscopical  Journal,"  vols.  12,  13,  and  16. 


240  MEDICAL  JURISPRUDENCE. 

The  general  manner  of  examination  may  be  briefly 
stated  to  be,  —  that  a  very  small  portion  of  the  stained 
fabric  or  material  should  be  cut  off;  or  if  the  stain  is 
found  on  a  hard  surface,  such  as  glass  or  steel,  a  minute 
fragment  should  be  removed  with  a  sharp  instrument, 
and  broken  into  fine  pieces  with  a  sharp  knife  upon  a 
glass  slide,  and  such  material  wet  with  a  few  drops  of  -§ 
of  1  per  cent  solution  of  common  salt  in  distilled  water, 
covered  with  a  thin  cover-glass  and  examined  with  a 
microscope.  For  the  purpose  of  making  comparative 
measurements  of  fresh  blood,  the  method  most  usually 
employed  is  —  having  first  impeded  the  return  circula- 
tion of  the  finger  by  a  thread  or  rubber  band  —  to  prick 
the  finger,  remove  a  small  drop  to  the  surface  of  a  slide 
or  cover-glass,  and  spread  the  same  in  a  thin  film  over 
such  surface  by  the  use  of  a  needle  or  the  edge  of 
another  slide,  allow  it  to  dry,  and  then  immediately 
examine  it  with  the  highest  power  at  the  disposal  of 
the  observer.  If  the  preparation  is  intended  to  be  per- 
manent, it  may  be  cemented  to  the  slide  in  the  usual 
way.  If  properly  prepared  it  will  keep  indefinitely. 

Corpuscles  thus  prepared  were  thought  by  the  late 
Dr.  Joseph  G-.  Richardson  to  flatten  out  a  little  in  dry- 
ing, so  as  to  give  an  average  diameter  slightly  in  ex- 
cess of  that  of  fresh  blood ;  but  the  difference  in  the 
case  of  the  human  blood-corpuscle  is,  according  to  his 
experiments,  only  that  between  -^^  and  the  3-5^3-  °^ 
an  inch. 

The  blood-corpuscles  of  man  and  of  all  mammals 
except  the  camel  tribe  are  circular,  flattened,  transpar- 
ent, non-nucleated  cells,  presenting  concave  sides.  In 
the  camel  tribe  the  corpuscles  are  oval,  but  contain  no 


PERSONAL  IDENTITY.  241 

nuclei.  In  birds,  reptiles,  and  fish,  the  corpuscles  are 
also  oval,  and  are  distinctly  nucleated.  The  shape  of 
the  corpuscles  found  in  examining  any  suspected  stain 
may  therefore  afford  conclusive  evidence  as  to  the  gen- 
eral nature  of  the  stain ;  that  is  to  say,  if  oval  and 
nucleated,  it  can  be  positively  affirmed  that  it  is  not  the 
blood  of  a  mammal ;  if  circular,  it  may  be  as  definitely 
affirmed  that  it  is  not  the  blood  of  a  bird,  reptile,  or  fish. 
It  should  be  remembered,  however,  in  this  connection, 
that  oval  corpuscles  as  well  as  ordinary  circular  cor- 
puscles may  be  rendered  globular  by  treatment  with 
water. 

In  the  examination  of  blood-corpuscles,  when  not 
dried  upon  the  slide  as  above  described,  a  so-called 
normal  solution,  such  as  the  common  salt  solution 
already  mentioned,  or  one  of  the  other  solutions  which 
may  be  found  described  in  the  larger  treatises  upon  this 
subject,  should  always  be  used. 

In  the  hands  of  a  competent  observer  there  is  very 
little  probability  that  any  other  bodies  will  be  mistaken 
for  blood-corpuscles;  starch-cells,  sporules  of  certain 
fungi,  and  the  discs  found  in  certain  coniferous  woods 
have  been  considered  as  the  most  likely  to  be  so 
mistaken. 

The  question  as  to  whether  blood  under  examination 
can  be  identified  positively  as  human  blood,  or  as  the 
blood  of  any  particular  animal,  has  been  very  much 
discussed.  According  to  the  experience  of  the  writer 
from  the  examination  of  650  corpuscles  taken  from  his 
own  finger,  examined  at  different  times,  but  under  as 
nearly  identical  conditions  as  possible,  it  appears  that  if 
the  average  of  a  sufficient  number  of  blood-corpuscles 

16 


242  MEDICAL  JURISPRUDENCE. 

is  taken,  namely,  not  less  than  100,  such  average  will 
be  found  to  be  sensibly  constant,  or  at  least  will  vary 
within  very  narrow  limits,  not  much,  if  any,  greater  than 
the  sum  of  the  personal  and  instrumental  errors. 

Whether,  however,  another  and  competent  observer 
would  have  arrived  at  the  same  average  from  the  meas- 
urement of  the  same  corpuscles  is  open  to  some  ques- 
tion. The  experience  of  the  author  in  micrometry  leads 
him  to  believe  that  very  much  of  the  discrepancy  found 
by  different  observers  to  exist  between  the  sizes  of 
blood-corpuscles  of  the  same  sort  of  animals  is  due  to 
several  causes,  namely :  that  the  average  is  taken  from 
the  measurement  of  too  small  a  number  of  corpuscles  ; 
that  the  eye-piece  micrometers  were  standardized  from 
stage  micrometers  whose  errors  were  not  known,  and 
from  too  small  a  number  of  observations ;  that  too  low 
a  power  was  used  in  making  such  examinations,  as  well 
as  the  use  of  a  defective  method  of  measurement ;  and 
finally,  although  perhaps  this  is  not  the  least  source 
of  error,  to  that  personal  error  which  necessarily  exists 
in  every  refined  measurement. 

In  order  to  test  the  relative  accuracy  of  micrometric 
measurements  with  different  apparatus  in  the  hands  of 
different  competent  observers,  the  author  recently  ruled 
on  a  glass  slide  15  spaces  of  approximately  .004  and 
.008  of  an  inch,  and  procured  the  same  to  be  measured 
by  six  well-known  microscopists,  who  were  instructed 
to  take  the  mean  of  at  least  five  measurements  of  each 
space  and  report  the  same  to  the  author.  The  result 
showed,  using  standard  micrometers  by  the  same  maker, 
that  the  measurements  of  the  same  space  by  different 
observers  varied  from  zero  to  .00011  of  an  inch. 


PERSONAL  IDENTITY.  243 

Whether  a  similar  discrepancy  will  be  found  to  ex- 
ist in  the  measurement  of  spaces  of  approximately  the 
diameter  of  a  human  blood-corpuscle,  with  a  high  power, 
is  in  process  of  investigation.  If  a  similar  discrepancy 
shall  be  found  to  exist  it  will  go  far  towards  explain- 
ing the  differences  in  the  size  of  corpuscles  found  by 
different  observers.  Had  a  single  measurement  only 
been  made  instead  of  taking  the  mean  of  five,  the  above 
discrepancy  would,  no  doubt,  have  been  much  greater. 
This  subject  seems  to  demand  more  attention  and  more 
careful  examination  than  it  has  hitherto  received. 

According  to  the  present  state  of  our  knowledge  it 
appears  to  be  settled  that  the  blood-corpuscles,  even  in 
the  fresh  state,  of  man,  dog,  rabbit,  guinea-pig,  muskrat, 
monkey,  elephant,  lion,  whale,  seal,  otter,  kangaroo, 
capybara,  wombat,  and  porpoise,  cannot  be  distinguished 
from  each  other  by  micrometric  measurement.  With 
respect  to  the  corpuscles  of  other  animals  presenting  a 
greater  difference  than  exists  between  the  corpuscles  of 
the  above-mentioned  animals  and  those  of  man,  it  seems 
to  the  writer,  in  the  light  of  the  investigations  above 
recorded,  that  it  would  be  extremely  perilous  to  un- 
dertake, by  mere  micrometric  measurements  alone,  to 
distinguish  the  blood  of  man  from  that  of  another 
mammal. 

It  is  possible  that  further  investigation  and  more 
extended  knowledge  of  the  relation  between  these  dif- 
ferent corpuscles,  and  of  the  sources  of  error  in  micro- 
metric  measurements,  may  enable  a  careful  observer  to 
distinguish  human  blood-corpuscles  from  those  of  some 
other  mammals ;  but  at  present  it  seems  somewhat  pre- 
sumptuous. 


244  MEDICAL  JURISPRUDENCE. 

For  full  details  respecting  such  micrometric  measure- 
ments as  have  been  made,  the  reader  is  referred,  in  ad- 
dition to  the  works  above  cited,  to  an  extended  series 
of  measurements  published  in  an  article  by  Dr.  Moses 
C.  White,  in  the  first  volume  of  the  "  Reference  Hand- 
book of  the  Medical  Sciences,"  page  587. 

It  should  also  be  borne  in  mind  in  this  connection 
that  not  only  the  number  but  the  size  of  human  red 
blood-corpuscles  is  changed  to  an  uncertain  extent  in 
some  diseases,  which  tends  to  make  more  uncertain  any 
conclusions  as  to  the  identity  of  blood  derived  from  the 
measurement  of  blood-corpuscles. 

2.  Chemical  Tests  for  Blood.  —  The  consideration  of 
the  physiology,  pathology,  and  chemistry  of  the  blood  is 
beyond  the  scope  of  this  treatise.  For  details  upon 
these  interesting  subjects  the  student  is  referred  to  pro- 
fessed treatises  upon  Physiology  and  Pathology,  and 
especially  to  Dr.  Charles's  "  Physiological  and  Patho- 
logical Chemistry." 

The  color  of  the  blood  is  due  to  the  presence  of 
a  very  complex  crystalline  substance  variously  called 
Haemoglobin,  haemato-globulin,  haematocrystallin,  cruorin, 
and  erythrocruorin.  This  coloring-matter  exists  in  the 
blood  under  two  forms:  the  oxidized  form,  which  is  of 
a  scarlet  color ;  and  the  deoxidized  form,  which  is  more 
or  less  purple.  Oxidized  haemoglobin,  oxyhaemoglobin, 
or  scarlet  cruorin,  is  found  in  arterial  blood ;  and  the 
reduced  haemoglobin,  or  purple  cruorin,  is  found  in 
venous  blood  combined  with  more  or  less  oxidized 
haemoglobin.  The  blood  found  in  a  dead  body,  pro- 
vided access  of  air  to  the  blood  is  prevented,  derives 
its  color  from  reduced  haemoglobin  and  gives  the  spec- 


PERSONAL  IDENTITY.  245 

tram  of  reduced  haemoglobin  only;  exceptions  to  this 
post-mortem  condition  of  the  blood  exist,  however,  after 
poisoning  by  hydrocyanic  acid,  after  death  by  cold  and 
starvation  (in  which  the  reducing  powers  of  the  tis- 
sue are  much  diminished),  and  especially  in  carbonic- 
oxide  poisoning,  where  the  blood  exhibits  the  particu- 
lar spectrum  of  carbonic-oxide  haemoglobin  hereinafter 
described. 

Haemoglobin  can  be  separated  from  the  corpuscles 
by  any  means  tending  to  their  dissolution, — as,  the 
addition  of  water  to  the  blood ;  the  passage  through  it 
first  of  a  current  of  oxygen  and  then  of  carbonic  acid ; 
freezing  and  subsequent  thawing,  repeated  several 
times  ;  electrical  discharges ;  agitation  of  the  blood  with 
ether ;  and  the  addition  to  the  blood  of  certain  salts  or 
of  crystallized  bile.  By  any  of  these  processes  the 
blood  is  rendered  transparent  or  laky. 

Haemoglobin  crystals  are  obtained  with  difficulty 
from  human  blood,  but  more  readily  from  that  of  the 
guinea-pig,  dog,  or  rat.  For  the  technique  of  their  sepa- 
ration, see  Dr.  Charles's  "  Physiological  and  Pathological 
Chemistry,"  page  199. 

Haemoglobin  is  remarkable  for  its  indiffusibility ;  it 
is  insoluble  in  absolute  alcohol,  ether,  chloroform,  or 
benzole ;  it  is  readily  soluble  in  water  and  in  weak 
alcohol,  and  also  in  alkaline  solutions,  but  is  decom- 
posed both  by  acids  and  alkalies,  when  the  body  now 
called  haematin  (also  a  very  complex  structure),  together 
with  an  albuminous  principle,  is  formed.  It  should  be 
noted,  however,  that  hsematin  is  not  formed  by  the 
action  of  hydrocyanic  acid  upon  haemoglobin.  Nearly 
all  the  iron  of  the  blood  is  contained  in  the  hsernatin. 


246  MEDICAL  JURISPRUDENCE. 

Haematin  is  a  bluish-black  amorphous  body,  forming 
a  reddish-brown  powder,  which,  when  burnt,  leaves 
behind  pure  oxide  of  iron.  It  is  insoluble  in  water, 
alcohol,  ether,  and  chloroform,  but  readily  soluble  in 
alkalies  or  alkaline  carbonates ;  it  is  with  difficulty 
soluble  in  acetic  or  the  mineral  acids,  and  hydrochloric 
acid  appears  to  be  the  only  one  of  these  that  dissolves 
it  without  its  iron  separating.  Solutions  of  hsematin 
are  dichroic,  being  reddish-brown  in  a  thick  layer,  and 
olive-green  in  a  thin  layer.  Like  hasmoglobin,  hsematin 
exists  in  an  oxidized  and  a  reduced  condition,  freshly 
reduced  haematin  passing  back  rapidly  into  the  ordi- 
nary form.  Haemoglobin,  where  the  blood  has  been 
kept  for  a  long  time,  becomes  changed  into  hsematin ; 
and  hsematin,  whether  produced  by  age  or  by  chemical 
actions,  like  haemoglobin,  in  its  two  states  of  oxidation 
has  separate  spectra. 

The  time  required  to  change  haemoglobin  into  me- 
thaemoglobin,  or  haematin,  varies  according  to  circum- 
stances ;  it  is  said  to  be  rapid  in  towns,  but  slow  in  the 
country,  and  to  be  especially  rapid  where  the  stain  is 
exposed  to  an  atmosphere  in  which  coal-gas  is  burnt, 
any  weak  acid  tending  greatly  to  accelerate  it.  The 
change  is  rapid  also  where  the  stained  fabric  has  been 
worn  next  to  the  skin.  As  a  rule,  it  may  be  said  that 
if  the  color  of  the  blood-stain  be  a  bright  red,  it  is  proof 
that  the  stain  is  recent ;  but  if  it  be  brown,  it  is  not 
proof  that  it  is  old. 

The  fact  that  haemoglobin  is  very  soluble  and  haematin 
very  insoluble,  is  of  great  medico-legal  importance. 
After  an  article  once  stained  with  blood  has  been 
washed  in  water  —  provided  sufficient  time  has  elapsed 


PERSONAL  IDENTITY.  247 

for  the  haemoglobin  to  be  converted  into  haematin — 
enough  will  in  all  probability  remain  to  serve  for  its 
identification ;  but  where  the  stain  is  perfectly  fresh, 
and  the  fabric  is  washed  in  cold  water  before  the  haemo- 
globin has  had  time  to  be  converted  into  haematin,  the 
whole  of  the  blood  may  be  so  effectually  removed  by 
efficient  washing  that  no  trace  will  remain ;  hot  water, 
however,  will  not  effect  the  removal  of  a  fresh  blood- 
stain like  cold  water,  owing  to  its  further  action  on  the 
coloring-matter  of  the  blood.  Where,  therefore,  in  a 
criminal  case,  it  appears  that  an  article  has  been  washed 
in  cold  water,  evidence  of  the  absence  of  blood-stains 
is  of  little  value ;  but  if  it  has  been  washed  in  hot 
water  the  probability  is  that  the  presence  of  the  blood, 
if  it  existed  on  the  fabric,  can  be  satisfactorily  demon- 
strated. The  age  of  the  stain  is  no  impediment  to  the 
spectroscopic  test  hereinafter  described.  Dr.  Sorby  has 
been  able  to  discover  the  spectrum  of  haematin  after 
forty-four  years,  while  Dr.  Tidy  states  that  he  has 
obtained  excellent  spectra  from  stains  which  he  had 
good  reason  to  believe  were  over  one  hundred  years 
old. 

The  further  consideration  of  the  spectroscopic  exami- 
nation of  the  blood  will  be  found  post. 

Haeinin  (Teichmann's  blood-crystals)  has  not  been 
found  pre-formed  in  animal  bodies  ;  it  is  a  bluish-black 
or  dark-brown  metallic-looking,  very  staple  crystalline 
powder.  It  is  almost  insoluble  in  dilute  acetic  acid, 
water,  alcohol,  ether,  and  chloroform  ;  but  is  soluble  in 
hydrochloric  and  sulphuric  acids  and  in  solutions  of 
the  alkalies  and  alkaline  carbonates,  but  is  decomposed 
in  its  solution.  Haemin  crystallizes  in  numerous  forms 


248  MEDICAL  JURISPRUDENCE. 

belonging  to  the  rhombic  system,  which  are  most  gener- 
ally small,  brown,  or  almost  black  rhombic  prisms  or 
tables. 

Teichmann's  test  for  haemin  crystals,  as  modified  by 
Buchner  and  Simon,  is  substantially  as  follows  :  The 
stained  portion  of  the  fabric  or  material  is  to  be  cut 
away  from  the  rest,  macerated  if  recent,  and  if  old, 
boiled  with  an  excess  of  glacial  acetic  acid  till  the  acid 
is  colored,  when  it  is  to  be  evaporated  to  dryness  on  a 
watch-glass  or  slide.  When  now  examined  with  a 
power  of  about  four  hundred  diameters,  the  character- 
istic crystals  of  haemin  should  be  found  if  the  stain  is 
blood,  existing  in  the  form  of  rhomboidal,  tabular,  or 
needle-shaped  crystals,  lying  across  one  another  in  star- 
shaped  masses,  varying  in  color  from  a  faint  yellowish- 
red  to  a  deep  blood-red.  As  the  presence  of  the  saline 
matter  of  the  blood  is  requisite  to  the  success  of  this 
process,  and  as  this  may  have  been  previously  all  washed 
away,  a  very  small  particle  of  common  salt  may  be 
added  to  the  acetic  acid  before  the  maceration  or  boil- 
ing, in  order  to  insure  the  appearance  of  the  crystals  ; 
some  advise  the  omission  of  the  salt  as  being  unneces- 
sary and  as  liable  to  encumber  the  field  with  crystals 
of  chloride  of  sodium ;  these,  however,  can  be  easily 
dissolved  out  by  water,  leaving  the  bsetniu  crystals  un- 
touched. To  preserve  the  crystals,  they  may  be  sealed 
up  in  acetic  acid,  or  the  surplus  acid  may  be  removed 
and  replaced  by  Farrant's  solution. 

An  alkaline  solution  of  hoemin  is  dichroic,  —  brown 
by  transmitted,  and  olive-green  by  reflected  light 

Teichmann's  test  has  been  shown  to  be  liable  to 
considerable  uncertainty,  for  the  reason  that  spots  of 


PERSONAL  IDENTITY.  249 

human  blood,  or  even  the  fluid  itself  in  appreciable 
quantity,  may  fail  to  yield  any  haemin  crystals  what- 
ever, or  only  such  as  are  of  so  indefinite  a  character  as 
to  be  utterly  worthless  for  diagnosis.  Similar  failures 
have  been  found  to  follow  attempts  at  bringing  out  the 
polychroism  of  the  blood,  even  in  the  hands  of  com- 
petent observers. 

In  testing  a  suspected  stain,  where  there  is  sufficient 
material,  the  action  of  cold  water  upon  the  stain  should 
be  particularly  noted ;  if  the  stain  is  recent  and  upon  a 
material  incapable  of  chemical  combination  with  any  of 
the  constituents  of  the  blood,  it  will  be  rapidly  dis- 
solved by  the  water,  the  solution  becoming  of  a  rich 
red  or  brownish-red  color ;  if  the  stain  is  not  fresh  but 
still  comparatively  recent,  it  is  less  rapidly  dissolved 
by  the  water  and  yields  a  solution  of  a  dirty-brown 
color ;  if  the  stain  is  very  old,  it  will  be  insoluble  in 
water,  the  haemoglobin  being  completely  changed  into 
hsematin. 

The  chemical  tests  for  blood  all  have  reference  to 
the  action  of  reagents  upon  its  coloring-matter.  If  the 
stain  be  upon  a  fabric,  cut  a  portion  out  and  treat  with 
cold  distilled  water ;  if  upon  a  porous  body,  such  as 
wood,  brick,  etc.,  the  stained  part  should  be  scraped  off 
for  some  depth,  reduced  to  a  fine  powder,  and  digested 
for  a  considerable  time  in  cold  distilled  water.  In 
either  case  the  liquid  should  be  filtered,  and  both  the 
matter  on  the  filtered  paper  and  the  filtrate  preserved 
for  examination.  If  the  stain  is  upon  iron  or  steel,  it 
may  be  peeled  or  scraped  off;  the  scrapings  will  con- 
sist of  a  mixture  of  blood  and  iron.  Digest  them  for 
several  hours  in  cold  distilled  water  rendered  slightly 


250  MEDICAL  JURISPRUDENCE. 

alkaline  by  ammonia,  and  should  this  fail  to  effect  the 
solution,  a  trace  of  citric  acid  may  be  used  instead. 
This  solution  should  be  filtered ;  the  iron,  except  a  trace 
of  citrate  where  citric  acid  has  been  used,  will  be  left 
on  the  paper.  The  blood  solution  thus  obtained  may 
be  tested  as  follows  :  — 

a.  Heat  a   small   quantity  in   a   test-tube   to  about 
149°  F;  with  a  blood  solution  three  results  will  follow: 
1.  The  red  color  is  destroyed.     2.  The  solution  is  coagu- 
lated.    3.  A  thick  brown  precipitate  is  produced,  de- 
pending in  amount  on  the  strength  of  the  solution. 

b.  If  this  brown  precipitate  is  present  in  quantity, 
it  should  be  collected  upon  a  filter-paper,  dried,  and 
heated  with   a  weak   ammonia   solution,  by  which,  if 
blood,  it  will  be  soluble.     The  solution,  if  sufficiently 
strong,  will  appear  dark-green  by  reflected,  and  red  by 
transmitted  light. 

c.  Where   the  stain  has   not  been  removed  from  a 
steel  blade,  a  tincture  of  galls  added  to  the  blood  will 
produce  a  red  precipitate. 

d.  If  the  red  solution  be  blood,  upon  the  addition  of 
a  very  weak  solution  of  ammonia  the  color  will  either 
remain  unchanged,  or  if  changed  will  be  slightly  inten- 
sified or  reddened. 

e.  A  solution  of  chlorine  will  effect  no  change  on  the 
coloring-matter  of  the  blood,  if  the  chlorine  solution  be 
but  moderately  strong. 

/.  Strong  nitric  acid  will  cause  the  blood  solution  to 
become  of  a  dirty-brown  color.  If  the  coagulated  mass 
is  sufficient  in  quantity,  heat  with  strong  nitric  acid, 
when  a  clear  yellow  solution  will  be  obtained. 

g.  If  a  solution  of  sodic  hydrate,  ten  grains  to  one 


PERSONAL  IDENTITY.  251 

ounce,  be  added  to  blood,  a  dark  olive  discoloration 
results,  which  on  treatment  with  excess  of  acetic  acid 
changes  to  red. 

Guaiacum  Test  —  Wet  the  blood-stain  with  freshly 
prepared  tincture  of  guaiacum,  and  then  add  a  small 
quantity  of  an  ethereal  solution  of  hydroxyl;  if  the 
stain  is  blood,  a  characteristic  blue  tint  will  be  pro- 
duced. If  the  material  stained  is  of  such  a  color  as  to 
obscure  the  reaction,  add  the  several  reagents  and  after- 
wards press  the  fabric  between  two  pads  of  white 
blotting-paper,  when  the  blue  color  will  be  absorbed  by 
the  paper.  In  this  test  the  blue  color  results  from  the 
oxidation  of  the  guaiacum  resin.  It  should  be  remem- 
bered, however,  that  guaiacum  is  turned  blue  by  a  great 
number  of  substances,  such  as  gluten,  milk,  the  fresh 
juice  of  a  variety  of  roots  (such  as  horse-radish,  col- 
chicum,  carrot,  etc.)  ;  also  by  nitric  acid,  chlorine,  the 
chlorides  of  iron  and  mercury,  copper  and  gold;  the 
alkaline  hypochlorites,  and  a  mixture  of  hydrocyanic 
acid  and  sulphate  of  copper ;  also  by  pus,  saliva,  and 
mucus  mixed  with  creosote  or  carbolic  acid. 

It  will  be  observed  that  to  all  the  foregoing  tests 
of  the  existence  of  blood,  except  the  miscroscopic  ex- 
amination for  blood-corpuscles,  there  are  serious  if  not 
fatal  objections.  Moreover,  a  larger  quantity  of  the  col- 
oring matter  of  the  stains  is  usually  required  for  the  sat- 
isfactory performance  of  these  tests  than  is  usually  found 
to  be  present  on  the  stains  submitted  for  examination. 

3.  Spectrum  Analysis.  —  By  this  test  in  the  hands  of  a 
competent  observer,  the  existence  of  blood  in  very  small 
quantities  may  in  many  instances  be  determined  with 
great  certainty. 


252  MEDICAL  JURISPRUDENCE. 

The  four  most  important  spectra  produced  by  blood 
are  the  following :  — 

1.  In  the  spectrum  of  oxyhaemogiobin  the  blue  end 
is  darkened ;  two  absorption   bands  are  visible  in  the 
yellower  half  of  the  green,  the  baud  nearest  the  violet 
end  being  about  twice  the  breadth  of  the  other  band. 

2.  In  the  spectrum    of   deoxidized  haemoglobin  the 
blue  end  is  darkened  but  somewhat  less  than  in  the 
case  of  oxyhsemoglobin ;  a  single  broad  absorption  baud 
is  visible  in  the  green. 

3.  In  the  spectrum  of  blood  after  short  exposure  to 
air  (metheemoglobin  or  haematin)  the  blue  end  is  dark- 
ened ;  the  two  bands  of  oxidized  haemoglobin  are  much 
weakened,  and  a  third  band  is  visible  in  the  red. 

4.  In  the  spectrum  of  reduced  or  deoxidized  haematin, 
the  blue  end  is  darkened ;  and  two  well-defined  bands 
are  visible  in  the  green,  somewhat  nearer  the  violet 
than  those   of  h£emoglobin ;  the  band  nearest  the  red 
end  is  the  narrower,  but  is  intensely  black,  and  has 
exceedingly  well-defined  edges.     The  band  nearer  the 
violet  is  nearly  double  the  width  of  the  other  band,  but 
the  edges  are  less  distinct ;  this  band  may  possibly  not 
be  seen  in  very  weak  solutions. 

In  the  examination  of  a  comparatively  recent  blood- 
stain on  a  white  fabric,  where  there  is  not  a  lack  of 
material,  cut  out  a  small  piece  of  the  stained  fabric 
and  soak  for  a  few  minutes  in  a  few  drops  of  cold  dis- 
tilled water  on  a  watch-glass;  then  squeeze  out  the 
colored  fluid  and  set  the  solution  by,  so  that  the  insol- 
uble matters  may  be  deposited.  Fill  several  experi- 
mental glass  cells,  made  of  barometer-tubing,  with  the 
solution. 


PERSONAL  IDENTITY.  253 

1.  Examine  the  aqueous   solution  with  the  micro- 
spectroscope,  when,  if  the  blood  be  tolerably  fresh,  the 
spectrum  of  oxyhaemoglobin  above  described  will  be 
apparent ;  if  such  a  spectrum  is  found  it  is  certain  that 
the  stain  is  tolerably  recent. 

2.  Add  to  the  solution  in  the  cell,  first,  a  trace  of 
ammonia,  and  then  a  minute  fragment  of  the  double 
tartrate  of  potash  and  soda  (Eochelle  salt)  ;  so  far  no 
change  will  appear.     Now  stir  in  a  small  piece  of  the 
sulphate  of  iron  and  ammonia,  with  as  little  as  possible 
exposure  of  the  solution  to  air,  and  cover  the  cell  with  a 
cover-glass.     The  two  absorption  bands  of  oxyhaemoglo- 
bin  will  now  be  replaced  by  a  single  intermediate  band, 
fainter  but  broader  than  those  previously  existing,  which 
is  the  spectrum  of  reduced  haemoglobin.     The  haemo- 
globin thus  reduced  may  be  oxidized  by  exposure  to  the 
air  with  vigorous  stirring,  and  again  deoxidized  by  fur- 
ther addition  of  the  iron  salt.     The  reduction  of  the 
haemoglobin  may  be  effected  spontaneously  by  merely 
covering  the  solution  over  with  a  cover-glass  and  keep- 
ing it  for  some  time  in  the  sealed  cell.     This  deoxidation 
and  reoxidation  of  the  haemoglobin  constitutes  a  very 
characteristic  reaction,  and  serves  to  distinguish  blood 
from  all  other  substances. 

3.  Stir  into  the  solution  in  a  cell  a  minute  fragment 
of  citric  acid,  which  will  convert  the  haemoglobin  into 
hsematin,  when  the  bands  of  the  oxy haemoglobin  will 
disappear;  and  if    the  solution  be  tolerably  strong  a 
faint  band  will  appear  in  the  red.      If  an  excess  of  am- 
monia be  now  added  the  band  in  the  red  will  disappear, 
the  original  bands  either  not  reappearing  or,  at  most,  to  a 
very  slight  extent.    If  now  to  the  solution  in  the  cell 


254  MEDICAL  JURISPRUDENCE. 

a  very  small  particle  of  the  double  sulphate  of  iron  and 
ammonia  be  added,  and  the  solution  immediately  covered 
with  a  cover-glass,  in  a  variable  time,  say  about  fifteen 
minutes,  the  well-marked  spectrum  of  reduced  haematin 
will  appear,  —  the  band  at  the  red  end  being  the  first  to 
appear.  If  this  solution  of  reduced  hoematin  be  exposed 
to  the  air  and  vigorously  stirred,  the  oxidized  haematin 
band  may  often  be  restored ;  and  also,  provided  the  con- 
version of  the  haemoglobin  in  the  first  instance  was 
incomplete,  the  bands  of  oxyhaemoglobin. 

The  late  Dr.  Joseph  G.  Richardson,  of  Philadelphia, 
who  has  given  great  attention  to  this  subject,  recom- 
mends the  following  method  of  examination  where  the 
quantity  of  material  is  very  small.  He  says  :  — 

"  Procure  a  glass  slide  with  a  circular  excavation  in  the 
middle,  called  by  dealers  a  '  concave  centre,'  and  moisten  it 
around  the  edges  of  the  cavity  with  a  small  drop  of  diluted 
glycerine.  Thoroughly  clean  a  thin  glass  cover,  about  one 
eighth  of  an  inch  larger  than  the  excavation,  lay  it  on  white 
paper,  and  upon  it  place  the  tiniest  visible  fragment  of  a 
freshly  dried  blood-clot  (this  fragment  will  weigh  from  ?;^ro 
to  OT^THT  °f  a  grain)-  Then  with  a  cataract  needle  deposit 
on  the  centre  of  the  cover,  near  your  blood-spot,  a  drop  of 
glycerine  about  the  size  of  this  period  (.),  and  with  a  dry 
needle  gently  push  the  blood  to  the  brink  of  your  micro- 
scopic pond,  so  that  it  may  be  just  moistened  by  the  fluid. 
Finally  invert  your  slide  upon  the  thin  glass  cover  in  such  a 
manner  that  the  glycerined  edges  of  the  cavity  in  the  former 
may  adhere  to  the  margins  of  the  latter,  and  turning  the 
slide  face  upwards,  transfer  it  to  the  stage  of  the  microscope. 

"By  this  method,  it  is  obvious,  we  obtain  an  extremely 
minute  quantity  of  a  strong  solution  of  haemoglobin,  whose 


PERSONAL  IDENTITY.  255 

point  of  greatest  density  (generally  in  the  centre  of  the  clot) 
is  readily  found  under  a  J  inch  objective,  and  tested  by  the 
adjustment  of  the  spectroscopic  eye-piece.  After  a  little 
practice  it  will  be  found  quite  possible  to  modify  the  bands 
by  the  addition  of  sulphuret-of-sodium  solution,  as  advised 
by  Preyer. 

"  In  order  to  compare  the  delicacy  of  my  plan  with  that 
of  Mr.  Sorby,  a  spot  of  blood  -^  of  an  inch  square  may  be 
made  on  a  piece  of  white  muslin,  the  threads  of  which 
average  100  to  the  inch.  When  the  stain  is  dry,  ravel  out 
one  of  the  colored  threads,  and  cut  off  and  test  a  fragment 
as  long  as  the  diameter  of  the  filament,  which  will  of  course 
be  a  particle  of  stained  fabric  measuring  -j-J-^  of  the  mini- 
mum-sized piece  directed  by  Mr.  Sorby.  When  the  drop  of 
blood  is  old  a  larger  amount  of  material  becomes  requisite, 
and  you  may  be  obliged  to  moisten  it  with  aqua  ammonice,  or 
with  solution  of  tartrate  of  ammonium  and  protosulphate  of 
iron ;  but  in  the  criminal  case  referred  to,  five  months  after 
the  murder  I  was  able  from  a  scrap  of  stained  muslin  •£$  of 
an  inch  square  to  obtain  well-marked  absorption  bands,  easily 
discriminated  from  those  produced  by  a  solution  of  alkanet- 
root  with  alum  and  those  caused  by  an  infusion  of  cochineal 
with  the  same  salt." 

In  the  examination  of  old  blood-stains  and  of  blood- 
stains on  colored  fabrics,  Dr.  Tidy  recommends  the  fol- 
lowing procedure :  If  the  blood-stain  be  old,  either  citric 
acid  or  ammonia  (preferably  the  latter)  should  be  used 
for  dissolving  the  coloring-matter.  If  the  fabric  be  col- 
ored, that  reagent  should  be  employed  which  possesses 
the  least  action  on  the  dye.  If  the  stain,  as  sometimes 
happens,  be  found  insoluble  in  both  ammonia  and  citric 
acid,  it  should  first  of  all  be  acted  upon  by  ammonia,  and 


256  MEDICAL  JURISPRUDENCE. 

a  moderate  heat  afterwards  applied.  The  solutions  ob- 
tained are  then  to  be  examined  in  the  manner  first  above 
described. 

The  presence  of  mordants  frequently  necessitates  some 
alteration  of  the  procedure,  the  blood  being  very  likely 
to  become  incorporated  with  the  mordant,  especially 
where  the  fabric  has  been  wet ;  in  such  case  filtration  or 
allowing  the  subsidence  of  the  deposit  is  equivalent  to 
removing  the  blood  coloring-matter.  The  same  details 
must  be  carried  out  as  above  described  and  the  turbidity 
of  the  liquid  overcome,  not  by  removing  the  precipitate 
but  by  increasing  the  intensity  of  the  transmitted  light. 

In  the  examination  of  stained  fabrics  that  have  been 
washed  with  water  after  staining,  the  blood  will  fre- 
quently be  found  spread  over  a  considerable  surface. 
In  such  case  a  large  piece  of  material  should  be  digested 
with  a  proportionately  large  quantity  of  ammonia  or  of 
citric  acid,  and  the  solution  concentrated  by  evaporation 
at  a  gentle  heat,  and  examined  with  a  micro-spectroscope 
in  the  manner  already  described.  In  the  examination 
of  the  water  used  for  washing  stained  garments  or  fab- 
rics, it  should  first  be  concentrated ;  if  in  such  concen- 
tration any  deposit  is  formed,  this  should  be  carefully 
collected,  treated  with  ammonia,  and  heat  applied  if 
it  be  insoluble  while  cold. 

Where  the  stained  fabric  has  been  washed  with  soap 
and  water,  the  haemoglobin,  by  the  action  of  the  alkali, 
will  be  found  converted  into  haematin;  in  such  case 
there  will  probably  be  little  difficulty  in  detecting 
blood  on  the  fabric  by  ordinary  means.  Where  it  is 
necessary  to  examine  the  soap-water  itself,  it  should  be 
agitated  with  a  large  bulk  of  ether  and  the  mixture 


PERSONAL  IDENTITY.  257 

allowed  to  stand  until  the  ether  has  well  separated. 
The  ether  should  then  be  removed  with  a  pipette  and 
the  residue  again  shaken  up  with  fresh  ether,  and  this 
should  be  repeated  until  the  aqueous  solution  is  per- 
fectly clear;  the  solution  remaining  is  to  be  concen- 
trated and  tested  for  blood  in  the  usual  manner. 

Blood-stains  on  leather,  or  upon  any  substance  con- 
taining tannic  acid,  require  special  management  on 
account  of  the  precipitation  of  the  coloring-matter.  In 
such  case  the  serum  frequently  soaks  into  the  leather, 
leaving  the  blood-corpuscles  on  the  surface.  Dr.  Tidy 
directs  that  in  such  case  a  fine  slice  be  shaved  off  from 
the  stained  portion  of  the  leather,  so  that  there  may  be 
as  much  blood  and  as  little  leather  as  possible  on  the 
shaving.  Bend  this  shaving  so  that  the  stained  side 
only  be  brought  into  contact  with  water  placed  in  one 
of  the  glass  cells  already  described.  In  this  manner  he 
says  that  a  solution  of  the  blood  coloring-matter  may 
probably  be  obtained.  Dr.  Sorby  suggests,  however, 
that  if  the  leather  has  been  washed  after  the  blood  has 
dried  upon  it,  it  will  probably  be  impossible  to  obtain 
the  blood-spectra  by  this  method.  The  following  pro- 
cedure in  such  case  is  said  to  work  satisfactorily:  — 

Digest  the  stained  leather  in  a  mixture,  by  measure, 
of  one  part  of  hydrochloric  acid  and  fifty  of  water,  for 
twenty-four  hours,  which  will  effect  a  solution  of  the 
mixed  compound  of  the  blood  coloring-matter  and  tannic 
acid ;  the  acid  liquid  is  then  to  be  poured  off,  but  not 
filtered.  The  solution  may  then  appear  almost  color- 
less, or  of  a  slight  yellow  tint.  To  it  add  an  excess  of 
ammonia,  when  the  color  will  become  either  a  pale  pur- 
ple or  a  neutral  tint,  the  tint-shade  being  considerably 

17 


258  MEDICAL  JURISPRUDENCE. 

intensified  by  the  addition  of  the  ferrous  salt  and  double 
tartrate,  which  are  now  to  be  added.  The  solution  is 
then  to  be  examined  in  an  experimental  cell  under  a 
light  sufficiently  intense  (such  as  the  lime-light  or  direct 
sunlight)  to  penetrate  the  turbid  solution,  when  the 
spectrum  of  deoxidized  hsematin  will  become  visible. 
If  the  liquid  be  too  turbid  to  allow  a  direct  ray  from 
the  sun  to  be  reflected  through  it,  the  cell  should  be 
placed  for  a  few  minutes  in  a  horizontal  position  so  that 
a  little  of  the  deposit  may  subside ;  remembering,  how- 
ever, that  the  removal  of  the  deposit  destroys  the  inten- 
sity of  the  spectrum,  —  the  greater  part  of  the  haematin 
existing  as  a  compound  insoluble  in  dilute  acid. 

In  the  examination  of  blood-stains  on  earth,  digest  the 
stained  earth  for  some  hours  in  a  considerable  quantity 
of  ammonia ;  pour  off  and  concentrate  the  solution,  and 
examine  the  turbid  solution  with  an  intense  light,  such 
as  the  lime-light  or  direct  sunlight.  A  similar  process 
should  be  adopted  in  the  case  of  stained  fabrics  soiled 
with  earthy  matters. 

In  conducting  micro-spectroscopic  examinations,  the 
following  general  advice  is  given  by  Dr.  Tidy :  — 

1.  If  the  fabric  on  which  the  blood-stains  occur  be  colored, 
the  spectrum  produced  by  the  coloring-matter,   extracted 
from  unstained  portions  of  the  fabric,  should  in  the  first 
instance  be  examined.     A  little  blood  may  be  placed  on  an 
unstained  portion,  and  when  dry  examined  with  a  spectro- 
scope, the  object  being  to  determine  at  the  outset  the  spec- 
trum of  the  dye  itself,  and  any  possible  interference  likely 
to  result  on  the  blood-spectra. 

2.  The  observer  should  on  no  account  decide  that  an 
observed  spectrum  from  a  suspected  stain  is  due  to  blood 


PERSONAL  IDENTITY.  259 

unless  it  exactly  coincides  with  the  bands  produced  by  a 
known  solution  of  blood  of  equal  strength,  treated  in  the 
same  manner. 

3.  The  spectra  should  in  all  cases  be  examined  both  by 
daylight  and  by  artificial  light.     Direct  concentrated  sun- 
light, or  the  lime-light,  should  be  tried  whenever  the  solution 
is  thick  and  turbid. 

4.  Never  be  content  with  observing  a  single  spectrum  of 
blood.      Remember,  further,  that  it  is  often  impossible  to 
obtain  the  unaltered  blood-spectrum ;  hence,  never  be  sat- 
isfied that  a  stain  is  not  blood  until  you  have  failed  to 
obtain  all  the  spectra  produced  by  the  action  of  appropriate 
reagents. 

5.  If  the  liquid  under  examination  is  too  strong,  so  much 
light  will  be  cut  off  that  the  absorption-bands  may  be  ob- 
scured ;  if  the  solution  is  too  weak  the  bands  will  become 
so  faint  that  they  are  likely  to  be  overlooked.     Solutions  of 
several  different  strengths  should,  if  possible,  be  examined. 

6.  Use  excessively  minute  quantities  of  the  several  re- 
agents. 

7.  Adjust  the  width  of  the  slit  of  the  spectroscope  during 
the  examination.     Absorption  bands  are  best  defined  when 
the  slit  is  very  narrow. 

8.  In  the  present   state   of  our  knowledge,   the   micro- 
spectroscope  affords  no  information  whatsoever  whether  the 
blood   comes  from  man   or  beast,  or  from  what   class   of 
animals  it  is  derived. 

As  to  whether  other  substances  give  spectra  similar  to 
those  of  blood,  Sorby  says  of  the  spectrum  of  oxyhaemo- 
globin :  "  I  do  not  know  of  anything  that  gives  exactly 
the  same,  but  there  are  some  things  which  give  bands 
so  far  similar  as  to  show  the  importance  of  studying  the 
effect  of  different  reagents." 


260  MEDICAL  JURISPRUDENCE. 

A  form  of  chlorophyll,  from  the  petals  of  the  red 
variety  of  cineraria,  gives  two  absorption  bands  which, 
though  dissimilar  in  relative  width,  are  nearly  similar 
in  position  to  those  of  oxyhsemoglobin.  With  ammonia, 
however,  the  absorption  bauds  of  blood  remain  un- 
changed, while  those  of  cineraria  are  completely  altered. 
The  reds  of  cochineal,  lac-dye,  alkanet,  madder,  and  mun- 
jeet,  dissolved  in  each  case  in  alum,  while  somewhat 
similar  in  their  absorption  bands  to  blood,  are  not,  when 
examined  side  by  side  with  blood,  likely  to  be  mistaken 
for  it  by  the  practised  observer;  all  are  changed  by 
ammonia,  and  all  are  bleached  by  potassic  sulphite, 
which  has  no  action  on  blood. 

Of  all  the  tests  for  blood  given  in  this  connection, 
the  discovery  of  red  blood-corpuscles  by  the  microscope 
and  the  micro-spectroscopic  examination  above  described 
alone  seem  to  be  without  fallacy.  In  the  present  state 
of  our  knowledge,  however,  it  is  impossible  to  determine 
whether  a  given  specimen  of  blood  is  or  is  not  human. 

Menstrual  Blood.  —  In  the  case  of  blood-stains  found 
on  the  clothes  of  a  female,  the  question  may  arise 
whether  or  not  the  blood  is  menstrual.  It  has  been 
stated  that  menstrual  blood  contains  no  fibrin,  is  acid, 
owing  to  its  admixture  with  vaginal  mucus,  and  that  it 
is  invaribly  associated  with  the  pavement  epithelium 
derived  from  the  vaginal  walls.  Such  pavement  epi- 
thelium, if  existing,  could  readily  be  demonstrated  by 
microscopical  examination;  and  this  last  peculiarity 
might  justify  an  inference  as  to  the  source  of  the  blood ; 
but  the  observer  would  rarely,  if  ever,  be  justified  in 
stating  a  positive  opinion  as  to  the  source  of  the  blood 
from  a  mere  microscopical  examination. 


CHAPTEE  XVII. 

LIFE   INSURANCE. 

Expectation  of  Life,  Presumption  of  Death,  etc.  —  A 
discussion  of  the  rules  of  law  upon  this  interesting  and 
important  subject  would  swell  the  size  of  this  book 
beyond  its  prescribed  limits.  We  can,  therefore,  in 
this  connection,  only  refer  to  those  topics  which  are  of 
special  interest  to  the  medical  examiner,  leaving  the 
legal  discussion  of  the  subject  where  it  more  properly 
belongs,  to  professed  treatises  on  the  Law  of  Insurance. 

Life  Insurance  is  a  contract  by  which,  in  considera- 
tion of  the  payment  by  the  insured  to  the  insurers  of 
a  certain  sum  of  money  called  a  premium,  either  in 
quarterly,  semi-annual,  or  yearly  instalments  or  in  a 
gross  sum,  the  insurers  agree  upon  the  death  of  the 
assured,  or  upon  his  arrival  at  a  certain  age,  or  upon  his 
death  before  that  time,  to  pay  either  to  him,  his  execu- 
tors, administrators,  or  assigns,  a  certain  sum  of  money. 
The  insurance  is  sometimes  effected  for  a  limited  num- 
ber of  years,  payment  of  the  sum  assured  to  be  made 
only  upon  the  death  of  the  insured  within  that  period. 
Insurance  is  also  effected  by  some  companies  against 
partial  or  total  disability  by  accident. 

The  writing  evidencing  this  contract  is  called  a  policy. 
The  policy  is  based  upon  an  application  in  writing  made 


262  .MEDICAL  JURISPRUDENCE. 

by  the  assured,  in  which  full  information  should  be 
given  upon  all  questions  affecting  the  risk,  such  as  age, 
occupation,  habits,  condition  of  health,  disease,  family 
history,  etc.  The  applicant  for  insurance  is  also  re- 
quired to  submit  to  examination  by  a  physician,  or 
physicians,  as  to  his  physical  condition.  The  answers 
to  the  questions  propounded  by  the  agent  or  examiner, 
as  well  as  the  statements  made  by  him  in  his  applica- 
tion for  insurance,  are  warranted  by  the  applicant  to 
be  true,  and  form  the  basis  of  his  contract  with  the 
company. 

Life  insurance  as  a  business  is  based  upon  the  expec- 
tation of  life.  Various  mortality  tables  have  been  from 
time  to  time  computed,  —  from  the  first  by  the  astrono- 
mer Edmund  Halley,  from  a  series  of  life-registers 
during  the  years  1687-91,  to  the  present  century.  The 
Actuaries',  or  Combined  Experience  Table  was  pub- 
lished by  Actuary  Jenkin  Jones  in  1843,  and  was 
based  upon  the  recorded  experience  of  seventeen  life 
companies  in  England,  and  was  deduced  from  62,537 
assurances,  under  the  superintendence  of  a  committee 
of  actuaries.  It  is  as  follows  : 


LIFE  INSURANCE. 


263 


COMBINED  EXPERIENCE   TABLE. 


Age. 

Expectation 
of  Life. 

Age. 

Expectation 
of  Life. 

Age. 

Expectation 
of  Life. 

10 

48.36 

40 

27.28 

70 

8.54 

11 

47.68 

41 

26.56 

71 

8.10 

12 

47.01 

42 

25.84 

72 

7.67 

13 

46.33 

43 

25.12 

73 

7.26 

14 

45.64 

44 

24.40 

74 

6.86 

15 

44.96 

45 

23.69 

75 

6.48 

16 

44.27 

46 

22.97 

76 

6.11 

17 

43.58 

47 

22.27 

77 

6.76 

18 

42.88 

48 

21.56 

78 

6.42 

19 

42.19 

49 

20.87 

79 

6.09 

20 

41.49 

50 

20.18 

80 

4.78 

21 

40.79 

61 

19.50 

81 

4.48 

22 

40.09 

52 

18.82 

82 

4.18 

23 

39.39 

53 

18.16 

83 

3.90 

24 

38.68 

54 

17.50 

84 

3.63 

25 

37.98 

55 

16.85 

85 

3.36 

26 

37.27 

56 

16.22 

86 

3.10 

27 

36.56 

57 

15.59 

87 

2.84 

28 

35.86 

58 

14.97 

88 

2.59 

29 

35.15 

59 

14.37 

89 

2.35 

30 

34.43 

60 

13.77 

90 

2.11 

31 

33.72 

61 

13.18 

91 

1.89 

32 

33.01 

62 

12.61 

92 

1.67 

33 

32.30 

63 

12.05 

93 

147 

34 

31.58 

64 

11.51 

94 

1.28 

35 

30.87 

65 

10.97 

95 

1.12 

36 

30.15 

66 

10.46 

96 

0.99 

37 

29.44 

67 

9.96 

97 

0.89 

38 

28.72 

68 

9.47 

98 

0.75 

39 

28.00 

69 

9.00 

99 

0.50 

264 


MEDICAL  JURISPRUDENCE. 


The  American  Experience  Table   of  Mortality  is  as 
follows :  — 


Age. 

Expectation 
of  Life. 

Age. 

Expectation 
of  Life. 

Age. 

Expectation 
of  Life. 

10 

38 

29.62 

57 

16.05 

20 

42.20 

39 

28.90 

58 

15.39 

21 

41.63 

40 

28.18 

69 

14.74 

22 

40.85 

41 

27.45 

60 

14.09 

23 

40.17 

42 

26.72 

61 

13.47 

24 

39.49 

43 

25.99 

62 

12.86 

25 

3881 

44 

25.27 

63 

12.26 

26 

38.11 

45 

24.54 

64 

11.68 

27 

37.43 

4G 

23.80 

65 

11.10 

28 

86.73 

47 

23.08 

66 

1064 

29 

36.03 

48 

22.36 

67 

10.00 

30 

35.33 

49 

21.63 

68 

9.48 

81 

34.62 

50 

20.91 

69 

8.98 

32 

33.92 

51 

20.20 

70 

8.48 

33 

33.21 

62 

19.49 

71 

8.00 

34 

32.50 

63 

18.79 

72 

7.64 

85 

31.78 

64 

18.09 

73 

7.10 

36 

31.07 

55 

17.40 

74 

6.68 

37 

30.35 

66 

16.72 

75 

6.28 

The  expectation  of  life,  that  is,  the  number  of  years 
on  an  average  that  a  healthy  person  at  a  certain  age 
•will  live,  excluding  all  persons  under  25  and  over  75 
years  of  age,  is  represented  by  the  formula  of  Willich, 
as  follows :  — 

x  =  f  (80  — a). 

In  which  x  represents  the  expectation  of  life  and  a 
the  age  of  the  person. 

Medical  Examination.  —  The  medical  examination  of 
an  applicant  for  an  insurance  should  be  made  by  a  man 
of  skill  and  experience,  and  in  by  no  means  as  superfi- 
cial and  perfunctory  a  manner  as  is  usually  the  case. 


LIFE  INSURANCE.  265 

The  scope  of  the  examination  will  necessarily  vary 
somewhat  according  to  the  requirements  of  the  different 
companies,  —  some  companies  requiring  an  investigation 
by  the  physician  of  the  family  history  and  a  personal 
medical  history,  as  well  as  an  investigation  of  the  appli- 
cant's personal  condition.  Assuming  that  it  is  the  duty 
of  the  examiner  to  make  the  more  extended  examination 
above  described,  he  should  ascertain  — 

1.  The  family  history  of  the  assured,  taking  care  that  it 
is  stated  clearly  and  fully,  with  no  ambiguity  of  terms, 
and  no  uncertainty  or  concealment.     General  and  in- 
definite  statements  by  the   assured  regarding   deaths 
should  be  explained.     Symptoms  as  effects  of  disease 
should  not  be  allowed  to  be  stated  in  the  place  of  the 
diseases   on   which  they  depend.     Particular   inquiry 
should  be  made  regarding  the  following  points  in  the 
family  record :  Have  there  been  two  cases  of  apoplexy, 
paralysis,  heart  disease  or  brain  affection,1  or  one  of 
each  pathologically  akin  ?    Have  there  been  two  cases 
of  Bright's  disease  or  cancer  ?     Have  any  two  members 
been  insane  ?     Have  the  questions  relative  to  the  final 
illness  of  the  members  of  the  family  who  have  died 
been  answered  particularly  as  to  duration  and  previous 
health  ? 

2.  The  Applicant's  personal  medical  History.  —  The 
inquiry  here  should  be  directed  to  the  point  whether  his 
present  and  past  condition  warrants  the  belief  that  the 
applicant  will  reach  advanced  age,  aside  from  the  acci- 
dents and  contingencies  common  to  all. 

1  For  many  of  the  rules  here  given  for  medical  examiners,  the  author 
is  indebted  to  the  printed  rules  prescribed  by  the  Mutual  Benefit  Life 
Insurance  Company  of  New  Jersey,  to  its  medical  examiners. 


266 


MEDICAL  JURISPRUDENCE. 


3.  The  Applicant's  personal  Condition.  —  Is  he  sound 
in  body  and  mind  ?  His  habits  as  regards  indulgence 
in  spirituous  or  malt  liquors,  opium,  or  tobacco,  or  in  any 
other  stimulant  or  narcotic,  should  be  carefully  investi- 
gated, and  the  organs  likely  to  be  injured  by  such  indul- 
gence carefully  examined.  The  temperature  should  be 
taken,  and  if  there  be  heat  of  skin,  it  should  be  observed 
before  he  is  undressed.  The  physique  and  complexion 
are  important  facts  in  determining  the  character  of  the 
risk;  a  flat  chest,  pigeon-breast,  protuberant  abdomen, 
local  muscular  atrophy,  disproportionate  height  and 
weight,  excessive  height,  stooping  gait,  curved  spine,  are 
all  serious  evidences  of  impairment.  Exact  and  not 
approximate  measurement  should  in  every  case  be  made. 
The  proper  average  relation  between  the  height  and 
weight  of  an  individual,  according  to  the  tables  pub- 
lished by  the  Mutual  Benefit  Life  Insurance  Company 
of  New  Jersey  and  by  the  Mutual  Life  Insurance  Com- 
pany of  New  York  (the  latter  of  which  was  compiled 
by  Dr.  Minturn  Post  and  Dr.  Isaac  Kipp  from  American 
lives),  is  as  follows  :  — 


M.  B.  of  N.  J. 

Height.                                 Weight. 

5  feet                         120  pounds 
5     "     1  inch            124      " 

M.  L.  of  N.  Y. 
Weight. 

pounds. 
120      " 

5     "     2    "                128      " 

125      " 

5     "     3 

132      " 

130      " 

5     "     4 

136      " 

135 

5 

5 

140      " 

140 

5 

6 

144      " 

143 

5 

7 

150      " 

145 

5 

8 

156      " 

148 

5 

9 

162      " 

155 

5 

10 

168      " 

160 

5 

11 

174      " 

165 

6                                  180      " 

170 

LIFE  INSURANCE.  267 

A  variation  of  20  pounds  at  5  feet  and  of  40  pounds 
at  6  feet,  and  in  the  same  proportion  at  intermediate 
heights,  will  not  be  considered  excessive. 

The  medical  examiner  should  examine  in  turn  — 

1.  The  Nervous  and  Muscular  Systems. 

2.  The  Respiratory  System.  —  Too   much   attention 
cannot  be  given  to  this  head.    Healthy  respiration  should 
be  quiet,  easy,  in  the  ratio  of  1  to  4  or  5  beats  of  the 
pulse  and  not  exceeding  20  per  minute  in  adults.     The 
chest  should  expand  freely  in  all  directions, — the  muscles 
of  the  neck  and  arm  taking  no  visible  part  in  the  act  of 
breathing;  the  respiratory  murmur  should  be  neither 
harsh  nor  noisy ;  drawing  a  full  breath  and  holding  it  for 
a  few  seconds  should  cause  no  distress ;  an  adult  should 
be  able  to  count  aloud  rather  slowly  from  20  to  30  with- 
out drawing  fresh  breath ;  if  the  blood  be  well  aerated, 
the  lips,  ears,  and  tips  of  the  fingers  should  present  no 
appearance  of  a  purple  or  livid  hue.     In  conducting  the 
examination  of  the  respiratory  and  circulatory  systems 
the  clothes  should  be  removed  from  the  chest,  and  as 
much  care  should  be  exercised  in  making  the  examina- 
tion as  if  the  physician  intended  to  prescribe  for  the 
applicant  as  a  patient. 

3.  The  Circulatory  System.  —  The  condition  of  the 
heart   should  be    particularly  examined.      The    pulse 
should  be  regular  and  not  jerking,  and  neither  too  com- 
pressible nor  too  hard ;  its  beat  should  be  about  4  or  5 
to  each  respiration,  and  in  the  case  of  the  adult,  sitting, 
should  not  be  below  65  or  70,  nor  above  80  per  minute, 
although  there  are  very  exceptional  cases  of  very  slow 
or  very  rapid  pulse  with  good  health.    Change  of  posture 
should  not  make  any  greater  difference  than  about  10 


2G8  MEDICAL  JURISPRUDENCE. 

beats  per  minute.  The  pulse  of  the  female  is  slightly 
more  rapid,  as  a  rule,  than  that  of  the  male  sex,  —  the 
average  number  of  beats  per  minute  of  a  healthy  female 
being  75,  while  that  of  a  male  is  70.  In  infancy  the 
average  number  of  beats  per  minute  is  from  120  to  100 ; 
childhood,  100  to  90  ;  youth,  90  to  75 ;  middle  age,  75 
to  65 ;  old  age,  70  to  60  ;  decrepit  age,  75  to  80. 

The  beats  of  the  heart  should  be  clear  and  unattended 
with  any  murmur,  blowing  or  rubbing  sounds  ;  the  first 
sound  should  be  louder,  longer,  and  lower  pitched ;  the 
apex  beat  of  the  heart  should  be  in  the  fifth  inter- 
costal space,  £  of  an  inch  within  and  about  1£  inches 
below  the  left  nipple,  and  the  impulse  while  plainly 
perceptible  should  neither  be  jerking  nor  too  widely 
diffused. 

Diseases  of  the  heart  have  practically  only  two  termi- 
nations :  (1)  sudden  death,  which  is  the  common  end- 
ing of  fatty  and  brown  degeneration,  dilatation  and 
atrophy,  aortic  regurgitatiou,  disease  of  the  coronary 
arteries,  etc. ;  and  (2)  dropsy,  which  is  a  common 
ending  to  most  forms  of  diseases  of  the  heart  and  its 
appendages. 

4.  The  Digestive  System.  —  Other  things  being  equal 
those  who  have  good  digestion  will  live  the  longest,  bear 
the  most  fatigue,  and  can  best  endure  the  risk  of  heat  and 
cold,  and  exposure.  Chronic  alcoholism  makes  a  decided 
impression  upon  this  system.  In  making  this  exami- 
nation the  state  of  the  tongue  and  mucous  membrane 
of  the  mouth,  the  appetite,  regularity  of  the  bowels, 
presence  or  absence  of  symptoms  of  dyspepsia,  size  of  the 
liver,  color  of  the  skin  and  conjunctivse,  etc.,  should  be 
principally  noted. 


LIFE  INSURANCE.  269 

5.  The  Genito-urinary  System. — Although  an  exami- 
nation of  the  urine  is  not  required  by  all  companies,  it  is 
by  some,  and  by  others  where  the  amount  insured  exceeds 
a  certain  sum.  In  our  judgment  no  medical  examina- 
tion even  approximates  to  completeness  without  an  ex- 
amination of  the  urine.  The  manner  of  conducting  this 
examination  is  not  within  the  scope  of  this  work.  When 
made,  the  examination  should  be  microscopical  as  well 
as  chemical. 

Even  when  the  rules  of  the  company  do  not  require 
it,  certain  symptoms  may  suggest  its  necessity.  The 
following  are  bad  indications  and  suggest  special  in- 
quiry :  oedema  of  the  eyelids,  backs  of  the  hand,  dor- 
sum  of  the  feet,  scrotum  and  vulva ;  nocturnal  micturi- 
tion ;  lumbar  pains ;  dysuria ;  presence  in  the  urine  of 
albumen,  sugar,  pus,  blood,  cancer-cells,  epithelial  and 
other  tube  casts  from  the  kidneys,  etc.  As  regards  the 
genital  organs,  sexual  incapacity  in  males  is  an  early 
symptom  of  many  neuroses ;  and  in  females,  the  uterus 
and  ovaries  are  favorite  seats  respectively  of  cancer  and 
of  cystic  disease.  In  the  male,  stricture  of  the  urethra, 
followed  as  it  often  is  by  grave  sequelce,  is  to  be  regarded 
as  an  element  of  danger. 

In  making  a  medical  examination  for  the  purposes 
of  insurance  much  must  of  necessity  be  left  to  the 
judgment  of  the  examiner;  and  to  undertake  to  give 
detailed  directions  would  in  most  instances  be  entirely 
unnecessary ;  only  a  few  general  hints  have  been  here 
attempted.  The  examiner,  besides  the  mere  personal 
examination  of  the  applicant,  should  always  bear  in 
mind  the  influence  of  habits,  place  of  residence,  occu- 
pation, climate,  etc.,  on  the  duration  of  life. 


270  MEDICAL  JURISPRUDENCE. 

The  influence  of  pregnancy  and  child-bearing  is  im- 
portant in  the  case  of  women.  While  very  few  women 
die  while  actually  in  a  state  of  pregnancy,  it  must  not 
be  assumed  that  pregnancy  is  a  shield  for  any  longer 
period  than  that  of  actual  gestation.  Again,  a  consider- 
able number  of  women  die  during  confinement;  of 
10,382  women  confined  for  the  first  time,  168  or  one  in 
every  62  died ;  while  of  26,394  multiparse,  213  or  one  in 
every  124  died.  There  can  be  no  doubt  that  much  of 
this  mortality  was  due  to  ignorance  and  carelessness ;  but 
so  long  as  ignorance  and  carelessness  are  possible,  they 
must  be  taken  into  account  in  determining  the  nature 
of  the  risk  when  application  is  made  for  insurance. 

Presumption  of  Death.  —  Where  by  a  policy  of  insur- 
ance the  sum  insured  is  payable  at  death,  the  burden  of 
proving  the  death  of  course  rests  with  the  administra- 
tors, executors,  or  those  benefited  by  the  death.  Death, 
being  proved,  is  to  be  regarded  as  due  to  natural  causes 
unless  the  contrary  is  shown.  By  the  common  law,  after 
the  lapse  of  seven  years  without  intelligence  concerning 
the  person  the  presumption  of  life  ceases,  and  the  burden 
of  proof  is  devolved  on  the  other  party.  Upon  an  issue 
of  the  life  or  death  of  a  party,  however,  the  jury  may 
find  the  fact  of  death  from  the  lapse  of  a  shorter  period 
than  seven  years,  if  other  circumstances  concur,  —  as,  if 
the  party  sailed  on  a  voyage  which  should  have  long 
since  been  accomplished  and  the  vessel  has  not  been 
heard  from ;  but  the  presumption  of  the  common  law, 
independent  of  the  finding  of  the  jury,  does  not  attach 
to  mere  lapse  of  time  short  of  seven  years,  unless  letters 
of  administration  have  been  granted  on  his  estate  within 
that  period,  which  is  in  such  case  a  conclusive  proof  of 


LIFE  INSURANCE.  271 

his  death.  Although  the  presumption  of  life  ceases  at 
the  expiration  of  seven  years  from  the  period  at  which 
the  person  is  last  heard  from,  in  the  absence  of  proof  it 
will  not  be  presumed  that  the  death  occurred  at  any 
particular  time  prior  to  the  lapse  of  the  seven  years. 
In  order  to  warrant  such  a  presumption  there  must  be 
evidence  other  than  the  mere  absence  of  the  party  with- 
out being  heard  from. 

It  is  said  to  be  the  practice  of  insurance  companies 
in  the  case  of  the  absence  unheard-of  of  the  assured  for 
a  considerable  time  under  circumstances  leading  to 
the  belief  of  his  death,  to  pay  the  policy  after  the  lapse 
of  a  year  or  two,  in  the  absence  of  any  suspicious 
circumstances. 

Presumption  of  Survivorship.  —  Most  treatises  upon 
medical  jurisprudence  contain  more  or  less  discussion 
upon  this  subject,  nearly  all  of  which  has  no  applica- 
tion whatever  to  the  administration  of  justice  in  courts 
where  the  common  law  prevails.  Where  the  succession 
to  an  estate  is  concerned,  the  question  which  of  two 
persons  is  to  be  presumed  the  survivor  where  both  per- 
ished in  the  same  calamity,  but  where  the  circumstances 
of  their  death  is  unknown,  is  by  the  common  law  a 
matter  to  be  determined  by  the  evidence,  no  positive 
rule  being  laid  down  upon  the  subject.  These  ques- 
tions are  not  to  be  decided  by  mere  presumption,  but 
are  to  be  tried  as  they  arise,  like  other  questions  of  fact. 
Courts  of  probate,  equity,  and  law  alike  refuse  to  pre- 
sume simultaneous  death  or  survivorship  in  the  absence 
of  evidence.  This  question  has  been  considered  in  the 
Roman  law  and  in  several  other  codes ;  for  the  full 
statement  of  the  rules  of  the  Roman  law  upon  this 


272  MEDICAL  JURISPRUDENCE. 

subject,  and  of  those  codes  which  have  in  this  respect 
followed  the  Roman  law,  see  1  "  Greenleaf  on  Evidence," 
sec.  29  et  seq. ;  and  1  "  Tidy's  Legal  Medicine,"  page  383 
et  seq. 

Insanity  and  Suicide.  —  The  subject  of  insurable  in- 
terest and  the  legal  effect  of  certain  conditions  to  be 
found  in  most  life  policies,  the  effect  of  concealment  of 
facts  material  to  the  risk,  etc.,  while  matters  of  great 
interest  and  importance,  do  not  properly  come  within 
the  scope  of  a  work  on  Legal  Medicine,  but  are  more 
properly  considered  in  legal  treatises  upon  Insurance. 

Most  policies  contain  provisions  relating  to  the  effect 
of  suicide,  providing  for  the  most  part  that  the  policy 
shall  be  void  if  the  insured  commit  suicide  or  shall  die 
by  his  own  hand,  whether  sane  or  insane.  Much  liti- 
gation has  arisen  as  to  the  effect  of  such  clauses,  but 
the  questions  discussed  in  the  recorded  cases  are  ques- 
tions of  law  rather  than  of  medicine,  and  do  not  come 
within  the  scope  of  this  work.  If  a  person  is  found 
dead,  questions  may  occur  under  some  policies  which 
will  require  the  aid  of  the  medical  jurist  in  determining 
whether  the  death  was  natural,  accidental,  suicidal,  or 
homicidal.  The  burden  of  proof  that  the  death  was 
not  natural  would  seem  to  rest  with  the  insurers,  and 
the  mode  and  cause  of  death,  when  the  question  arises, 
is  to  be  determined  upon  principles  discussed  in  other 
chapters.  It  may  be  stated  in  passing,  that  it  is  well 
settled  that  suicide  is  not  proof  of  insanity.  See  post, 
chapter  upon  INSANITY. 


CHAPTEE  XVIII. 

FEIGNED,  FACTITIOUS,   AND  LATENT  DISEASES. 

Definitions.  —  A  feigned  disease,  strictly  so  called,  is 
one  which  is  altogether  fictitious. 

A  factitious  disease  is  one  which  is  wholly  produced 
by  the  patient,  or  at  least  with  his  connivance. 

A  latent  disease  is  a  real  disease  which  presents  little 
or  no  outward  manifestation  during  life,  and  is  only  de- 
tected on  inspection  after  death. 

To  this  classification  some  writers  add  exaggerated 
diseases,  or  those  which,  existing  in  some  degree  or 
form,  are  pretended  by  the  party  to  exist  in  a  greater 
degree  or  a  different  form ;  and  aggravated  diseases,  or 
those  which  originate  in  the  first  instance  without  the 
person's  concurrence,  and  are  intentionally  increased 
by  artificial  means. 

1.  Feigned  diseases  are  simulated  from  a  variety  of 
motives,  such  as  avoidance  of  military  and  naval  service, 
the  obtaining  of  a  pension,  escape  from  imprisonment 
or  other  punishment,  obtaining  alms  from  the  charita- 
ble, obtaining  damages  in  courts  of  law  for  simulated 
iujuries  alleged  to  have  been  received  in  railway  acci- 
dents, and  from  many  other  motives  too  numerous  to 
mention. 

18 


274  MEDICAL  JURISPRUDENCE. 

Simulated  insanity  will  be  considered  in  another  con- 
nection. Feigned  poisoning  will  be  considered  under 
TOXICOLOGY.  Pretended  delivery  has  already  been  re- 
ferred to. 

The  diseases  best  adapted  for  the  purpose  of  simula- 
tion are  those  of  a  chronic  kind,  in  which  the  symptoms 
are  purely  subjective  and  produce  no  apparent  disturb- 
ance of  the  system,  and  consequently  call  for  less  self- 
denial  on  the  part  of  the  simulator ;  and  owing  to  their 
existence  resting  mainly  on  the  veracity  of  the  patient, 
are  less  easily  proved  to  be  simulated.  Although  cases 
of  simulation  are  more  often  met  with  in  the  army  and 
navy,  they  are  not  unfrequently  encountered  in  hospital, 
dispensary,  and  private  practice. 

The  consideration  of  this  subject  must  necessarily 
consist  principally  in  the  narration  of  particular  cases, 
many  of  which  are  to  be  found  in  the  larger  treatises  on 
Medical  Jurisprudence.  A  few  only  will  be  stated  in 
this  connection. 

Dr.  Ogston  relates  the  case  of  a  beggar  in  Aberdeen, 
who  simulated  elephantiasis  very  successfully.  The  pre- 
tended swelling  was  confined  to  one  leg  below  the  knee, 
and  was  produced  by  padding ;  to  favor  the  deceit,  part 
of  the  leg  was  covered  with  gold-beater's-skin,  and 
exposed  by  drawing  down  his  stocking  two  or  three 
inches. 

Epilepsy  is  a  disease  frequently  simulated  by  beggars ; 
and  next  to  that,  according  to  Ogston,  the  loss  of  an 
arm.  To  give  color  to  a  feigned  attack  of  epilepsy,  a 
ligature  around  the  neck  has  been  applied  to  induce 
reddening  of  the  face ;  soap  in  the  mouth  to  imitate 
froth  about  the  lips,  and  the  gums  have  been  pricked 


FEIGNED  DISEASES,  ETC.  275 

to  give  the  tongue  the  appearance  of  having  been  bitten. 
It  would  be  impossible,  in  such  cases,  for  the  impostor 
to  imitate  the  fixing  or  twitching  of  the  eyeballs,  the 
insensibility  of  the  pupils,  the  peculiar  perturbation  of 
the  heart,  rigidity  of  the  muscles,  and  the  insensibility 
of  the  skin  and  mucus  outlets ;  while  the  prodrornata 
and  the  sequelae  of  the  attack,  if  ascertainable,  would 
assist  further  in  determining  the  nature  of  the  suspected 
simulation. 

Eeal  epilepsy  often  offers  considerable  variety  in  its 
character,  —  one  attack  being  a  mere  momentary  loss  of 
consciousness  (Ic  petit  mal),  while  another  may  consist  of 
the  most  violent  convulsions  (le  grand  mal).  Impostors 
usually  simulate  the  severer  type,  with  the  peculiar  cry, 
falling  down,  struggling,  lividity,  frothing  at  the  mouth, 
etc. ;  but  they  often  omit  to  feign  any  of  the  sequelae  of 
true  epilepsy.  Many  such  cases  have  been  unmasked 
by  threats,  or  by  quietly  bringing  some  sharp  or  hot 
substance  into  contact  with  some  part  of  the  body. 
Calmeil  is  said  to  have  detected  a  simulator,  who  fell 
in  a  pretended  fit  on  a  heap  of  straw  in  the  street,  by 
ordering  the  straw  to  be  set  on  fire. 

The  true  epileptic  usually  falls  forward,  and  thus 
frequently  injures  his  nose,  forehead,  chin,  or  cheeks. 
As  he  falls  he  is  deadly  pale,  not  red ;  tonic  convulsions 
immediately  begin,  the  trunk  muscles  being  nearly 
always  affected  as  well  as  the  others;  the  muscular 
rigidity  is  not  to  be  overcome,  or  only  with  great  diffi- 
culty :  once  overcome,  the  muscles  remain  flaccid  until 
some  time  after,  or  until  another  fit  sets  in ;  the  face 
only  reddens  after  a  time,  and  then  the  veins  of  the 
neck  swell,  etc.  Then  clonic  convulsions  set  in;  the 


276  MEDICAL  JURISPRUDENCE. 

pupils  are  usually  dilated  and  refuse  to  contract  under 
the  stimulus  of  a  strong  light ;  the  sense  of  smell  is  also 
abolished,  and  strong  aqua  ammonias  may  be  held  to  the 
nose  with  impunity.  The  attack  is  succeeded  in  severe 
cases  by  torpor,  drowsiness,  and  confusion  of  mind, 
which  last  for  some  hours,  and  the  patient  is  left  very 
weak.  Impostors  usually,  as  in  insanity,  overact  their 
part ;  their  contortions  are  too  violent,  and  they  mix  up 
all  the  stages  of  the  complaint,  usually  disregarding  the 
sequelae. 

Deafness  and  dumbness  are  very  frequently  simulated, 
as  well  as  neuralgia,  spinal  irritation,  muscular  debility, 
spasms,  paralysis,  contraction  of  joints,  and  rheumatism, 
—  all  of  which  demand  no  great  self-denial,  and  but 
little  cunning  on  the  part  of  the  simulator.  In  dumb- 
ness, impostors  seldom  attempt  more  than  ceasing  to 
speak,  and  in  paralysis,  ceasing  to  move  about ;  in  both 
cases  the  sudden  development  and  confirmed  state  of 
the  alleged  disease  from  the  outset  should  excite  suspi- 
cion. Dr.  Ogston  relates  the  case  of  a  prisoner  in  the 
Aberdeen  jail  who  pretended  sudden  and  total  deafness, 
and  whose  imposition  was  detected  by  dropping  at  his 
back  a  huge  bunch  of  keys  from  a  high  window,  without 
his  being  at  all  startled  or  taking  any  notice  of  it ;  while 
the  same  thing,  done  in  a  case  of  congenital  deaf-mutism, 
caused  the  prisoner  to  start  in  alarm  and  look  around 
in  all  directions  except  that  from  which  the  sound  or 
impulse  had  come. 

True  deaf-dumbness  occurs  only  in  congenital  cases. 
The  Abbe"  Sicard  is  said  to  have  detected  one  impostor 
by  noticing  that  his  spelling  of  written  words  was  pho- 
netic. Feigned  deafness  may  sometimes  be  detected  by 


FEIGNED  DISEASES,  ETC.  277 

the  exercise  of  a  little  pious  fraud.  Dr.  Taylor  records 
one  case  where  a  pauper,  feigning  deafness,  was  detected 
by  the  production  of  a  case  of  surgical  instruments 
during  the  conversation  of  the  two  surgeons  regarding 
the  immediate  performance  of  an  operation  upon  him. 
Some  startling  statements  may  be  whispered,  the  coun- 
tenance, pulse,  etc.,  of  the  supposed  simulator  being 
watched  meanwhile. 

Haemoptysis  has  frequently  been  mimicked  by  first 
swallowing  the  blood  of  animals  and  ejecting  it  in  the 
presence  of  witnesses. 

Scurvy  has  been  imitated  by  irritating  and  pricking 
the  gums. 

The  unhealthy  hue  or  yellowness  of  the  skin  in 
chronic  dyspepsia,  jaundice,  and  hepatitis,  has  been 
simulated  by  the  use  of  emetics  and  purgatives,  by  the 
use  of  skin  dyes,  or  by  the  natural  or  acquired  facility 
of  ejecting  the  contents  of  the  stomach  at  pleasure. 

The  appearance  of  amaurosis  has  been  imitated  by 
the  application  to  the  eye  of  belladonna,  hyoscyamus, 
or  atropine  to  insure  the  dilatation  and  insensibility  of 
the  pupils.  A  thorough  knowledge  of  ophthalmic  medi- 
cine and  surgery  and  some  acquaintance  with  optics  are 
necessary  in  order  to  detect  some  clever  impostors.  An 
ophthalmoscopic  examination  will  here  prove  of  great  as- 
sistance ;  the  use  of  atropine  for  the  purpose  of  paralyz- 
ing the  accommodation  will  often  be  necessary,  when  it 
will  be  frequently  found  that  the  pretender  of  myopia  or 
near-sight  cannot  see  the  test  types  with  concave  lenses 
which  would  suit  a  real  sufferer,  and  the  reverse. 
Feigned  double  vision  may  usually  be  detected  by  col- 
ored glasses  and  the  use  of  prisms.  The  simulation  of 


278  MEDICAL  JURISPRUDENCE. 

complete  blindness  is  the  most  difficult  of  exposure. 
Pretended  blindness  of  one  eye  may  often  be  detected 
by  a  prism,  placed  base  upwards  or  downwards  before 
the  sound  eye,  the  double  vision  produced  furnishing 
the  required  proof. 

Contraction  and  rigidity  of  the  large  and  small  joints 
are  often  affected  by  soldiers  and  beggars  ;  and  some 
color  is  occasionally  given  to  the  imposture  by  keep- 
ing the  limb  at  rest  by  bandages  till  some  stiffness 
and  wasting  of  the  muscles  ensue;  a  feigned  dieases 
may  thus  occasionally  be  converted  into  a  factitious 
one. 

Simulated  nervous  diseases,  such  as  hemiplegia,  para- 
plegia, catalepsy,  etc.,  may  frequently  be  detected  by 
the  intelligent  use  of  electricity  ;  in  such  cases  the  tem- 
perature, change  of  nutrition,  reflex  movements,  pecu- 
liar eruptions,  etc.,  if  they  exist,  may  throw  light  on 
the  solution  of  the  question. ' 

As  most  impostors  have  little  or  no  knowledge  of 
many  of  the  diseases  which  they  simulate,  the  simula- 
tion can  often  be  detected  by  the  patient's  enumerating 
incompatible,  improbable,  or  impossible  symptoms. 

An  accurate  knowledge  of  the  symptoms,  course,  and 
pathology  of  disease,  with  watchfulness  and  attention  to 
the  surrounding  circumstances,  and  a  few  simple  tests 
such  as  will  suggest  themselves  to  the  intelligent  practi- 
tioner, will  in  most  cases  disclose  the  fraud.  The 
resources  of  medical  art  have  of  late  years  been  so  in- 
creased by  the  thermometer,  microscope,  ophthalmo- 
scope, stethoscope,  laryngoscope,  electrical  apparatus, 
sphygmograph,  etc.,  that  the  exposure  of  fraud  is  now 
much  easier  than  it  once  was. 


FEIGNED  DISEASES,   ETC.  279 

Many  amusing  instances  of  the  exposure  of  attempted 
simulations  are  to  be  found  in  the  books.  Thus,  Pare' 
mentions  a  beggar  who  had  introduced  a  long  piece  of 
bullock's  gut  into  his  rectum  in  order  to  imitate  pro- 
lapsus ani;  from  the  bowel  which  was  filled  with  a 
mixture  of  blood  and  milk,  he  had  learned  to  press  out 
drops  at  pleasure.  A  kick  from  the  foot  of  the  in- 
spector made  the  gut  tumble  out  and  disclosed  the 
imposture. 

For  further  cases  the  reader  is  referred  to  the  larger 
treatises  of  Taylor,  Ogston,  and  other  writers. 

2.  Factitious  Diseases.  —  Scrofulous  and  other  sores, 
stiffening  and  contraction  of  the  joints,  fistula  in  ano, 
ophthalmia,  cutaneous  eruptions,  and  many  other  ail- 
ments are  included  in  this  category.  Sores  have  been 
produced  in  the  neck  simulating  scrofulous  ulcers,  by 
the  use  of  escharotics,  and  the  deceit  strengthened  by 
the  application  of  the  juice  of  euphorbium  to  favor  the 
swelling  and  redness  of  the  eyelids,  nose,  and  lips. 

Inflation  of  the  scrotum  to  simulate  hydrocele,  or  of 
the  areolar  tissue  elsewhere  to  resemble  oedema,  would 
only  deceive  a  novice.  (Edema  has  been  produced  by 
ligatures.  There  are  recorded  instances  of  pretenders 
having  so  overdone  their  parts  in  this  respect  as  to  pro- 
duce gangrene  of  the  arm  or  leg. 

Diarrhoea  and  dysentery  have  been  simulated  by 
taking  strong  cathartics. 

Ophthalmia  may  be  produced  artificially  by  the  appli- 
cation of  various  irritants  to  the  eye. 

Various  cutaneous  affections  have  been  successfully 
imitated  by  the  use  of  a  variety  of  irritants  applied  to 
the  skin. 


280  MEDICAL  JURISPRUDENCE. 

Tinea  capitis  has  been  imitated  by  the  application  of 
nitric  acid  to  the  scalp,  previously  protected  by  some 
fatty  substance. 

This  list  might  be  very  much  lengthened,  but  enough 
has  probably  been  said  upon  this  subject. 

In  the  examination  of  cases  of  both  suspected  ficti- 
tious and  factitious  diseases,  the  inspector  should  be 
well  acquainted  with  the  disease  simulated  and  with 
the  means  which  may  be  resorted  to  for  producing  the 
appearance  of  morbid  actions  or  discharges.  The  his- 
tory of  the  person  will  often  throw  light  upon  the  ques- 
tion ;  the  suspected  impostor  should  be  encouraged  to 
give  full  accounts  of  the  origin,  progress,  duration,  and 
symptoms  of  his  disease;  to  do  this  correctly  will  in 
the  majority  of  cases  require  more  knowledge  than  is 
possessed  by  a  non-medical  man. 

Anaesthetics  will  sometimes  assist  in  unmasking  a 
fraud  ;  in  cases  of  doubt,  however,  it  is  more  charitable 
to  assume  for  the  time  being  that  the  patient's  state- 
ments are  true  than  to  run  the  risk  of  inal-treating  or 
neglecting  a  case  of  real  disease.  The  possibility  of 
latent  disease  in  a  person  supposed  to  be  an  impostor, 
should  also  be  borne  in  mind. 

See  an  interesting  case  narrated  by  Dr.  Ogston,  on  page 
340  of  his  excellent  work  on  Medical  Jurisprudence. 

3.  Latent  Diseases.  —  It  is  a  fact  well  known  to  physi- 
cians that  many  disorders,  even  those  of  which  the 
presence  is  commonly  indicated  by  well-marked  symp- 
toms, may  in  particular  cases  present,  throughout  the 
whole  or  a  greater  part  of  their  course,  a  material 
deficiency  or  total  absence  of  their  usual  external  char- 
acters or  symptoms ;  and  on  this  account  they  are 


FEIGNED  DISEASES,  ETC.  281 

frequently  confounded  with  other  diseases,  or  entirely 
escape  observation.  As  stated  by  Sir  Robert  Christi- 
son,  nothing  is  more  common  in  the  practice  of  medical 
jurisprudence  than  for  the  expert  to  find  his  opinion 
and  conduct  embarrassed  by  sudden  death  arising  in 
the  like  circumstances,  by  the  discovery  of  appearances 
in  the  dead  body  adequate,  apparently,  to  account  for 
death,  yet  unconnected  with  any  traces  of  the  existence 
of  corresponding  disease  during  life. 

In  the  list  of  latent  diseases,  Sir  Robert  Christison 
enumerates  (with  perhaps  some  latitude  in  the  use  of 
the  term  latent)  apoplexy,  cerebral  meningitis,  cerebral 
inflammation,  pleuritis,  pneumonia,  pneumothorax,  pul- 
monary tubercle,  diseases  of  the  great  vessels  within 
the  chest,  such  as  aneurism,  and  affections  of  the  abdo- 
men and  spine. 

Dr.  Ogston  remarks  that  the  term  "latent  disease" 
applies  with  most  force  to  such  diseases  as  cerebral 
meningitis,  softening  of  the  cerebral  lobes  of  the  brain, 
and  abscess  in  its  substance;  instances  of  which  he 
says  he  has  encountered  in  practice  where  no  complaint 
of  illness  was  made  until  within  a  few  hours,  or  days  at 
most,  of  the  fatal  event. 

Some  fatal  diseases  of  the  heart,  aneurisms  of  the 
large  vessels,  and  apoplexy  most  nearly  approach  what 
may  be  called  strictly  latent  diseases. 

A  full  consideration  of  this  interesting  subject  would 
occupy  too  much  space ;  for  further  particulars  the 
student  is  referred  to  Dr.  Ogston's  work  and  to  standard 
treatises  on  the  Practice  of  Medicine. 


CHAPTER   XIX. 

MALPRACTICE. 

MALPRACTICE  may  be  considered  under  two  heads: 
civil,  and  criminal. 

1.  Civil  Malpractice.  —  The  gist  of  an  action  for  civil 
malpractice  is  negligence.  The  rules  of  law  governing 
this  important  subject  are  well  stated  by  Judge  Cooley 
in  his  work  on  Torts.  We  cannot  do  better  than  quote 
his  language:  — 

"As  the  promise  is  not  different  in  the  case  of  the  physi- 
cian and  surgeon  from  what  it  is  in  the  case  of  the  attorney, 
solicitor,  and  proctor,  one  general  rule  may  be  given  which 
will  apply  to  all. 

"  The  English  authorities  are,  perhaps,  somewhat  more 
indulgent  to  the  faults  and  mistakes  of  professional  men 
than  are  those  of  this  country.  Thus,  Lord  Campbell,  with 
the  full  concurrence  of  his  associates  in  the  House  of  Lords, 
declared  that  in  order  to  maintain  an  action  against  one's 
legal  adviser,  it  was  necessary,  '  most  undoubtedly,  that  the 
professional  adviser  should  be  guilty  of  some  misconduct, 
some  fraudulent  proceeding,  or  should  be  chargeable  with 
gross  negligence  or  with  gross  ignorance.  It  is  only  npon 
one  or  the  other  of  these  grounds  that  the  client  can  main- 
tain an  action  against  the  professional  adviser.' 

"  On  the  other  hand  the  rule  is  laid  down  in  Pennsylvania 
that  the  professional  man  must  bring  to  the  practice  of 


MALPRACTICE.  283 

his  profession  a  degree  of  skill  and  diligence  such  as  those 
'  thoroughly  educated  in  his  profession  ordinarily  employ.' 
This  is  a  severe  rule,  and  fixes  a  standard  of  professional 
skill  and  attainments  which,  in  the  newer  portions  of  the 
country,  would  be  quite  out  of  the  question.  In  New  Hamp- 
shire the  undertaking  of  the  practitioner  has  been  stated  in 
the  following  language  :  '  By  our  law  a  person  who  offers  his 
services  to  the  community  generally,  or  to  any  individual, 
for  employment  in  any  professional  capacity  as  a  person  of 
skill,  contracts  with  his  employer:  1.  That  he  possesses 
that  reasonable  degree  of  learning,  skill,  and  experience  which 
is  ordinarily  possessed  by  the  professors  of  the  same  art  or 
science,  and  which  is  ordinarily  regarded  by  the  community 
and  by  those  conversant  with  that  employment  as  necessary 
and  sufficient  to  qualify  him  to  engage  in  such  business. 
2.  That  he  will  use  reasonable  and  ordinary  care  and  dil- 
igence in  the  exertion  of  his  skill  and  the  application  of  his 
knowledge  to  accomplish  the  purpose  for  which  he  is  em- 
ployed. He  does  not  undei'take  for  extraordinary  care  or 
extraordinary  diligence,  any  more  than  he  does  for  uncom- 
mon skill.  3.  In  stipulating  to  exert  his  skill  and  apply  his 
diligence  and  care,  the  medical  and  other  professional  men 
contract  to  use  their  best  judgment."  This  is  believed  to  be 
an  accurate  statement  of  the  implied  promise.  The  practi- 
tioner must  possess  at  least  the  average  degree  of  learning 
and  skill  in  his  profession  in  that  part  of  the  country  in 
which  his  services  are  offered  to  the  public  ;  and  if  he  exer- 
cises that  learning  and  skill  with  reasonable  care  and  fidel- 
ity, he  discharges  his  legal  duty." 

A  physician  possessing  a  reasonable  degree  of  learning 
and  skill,  and  exercising  according  to  his  best  judgment 
reasonable  and  ordinary  care  and  diligence,  is  not  liable 
for  a  mere  error  of  judgment  in  advising  a  particular 


284  MEDICAL  JURISPRUDENCE. 

remedy  about  which  there  is  a  difference  of  opinion. 
To  hold  a  physician  liable  for  every  error  of  judgment 
made  in  the  ordinary  course  of  practice  would  be  to 
debar  him  from  the  exercise  of  his  profession,  and  to 
deprive  the  public  of  the  benefit  of  valuable  service. 
The  law  does  not  require  infallibility.  A  medical  man 
cannot,  as  a  rule,  be  held  guilty  of  negligence  for  not 
employing  any  particular  remedy,  since,  as  a  rule,  there 
is  never  any  one  specific  remedy  in  the  use  of  which  all 
authorities  are  agreed.  If  it  could  be  shown,  however, 
that  all  authorities  agreed  that  a  particular  drug  should 
be  used  in  a  particular  case,  as,  for  example,  a  certain 
antidote  in  a  case  of  poisoning,  the  failure  to  employ 
such  specific  would  probably  constitute  actionable 
negligence. 

A  physician  may  decline  a  case,  but  having  once 
undertaken  it,  he  must  continue  his  services,  even  if 
gratuitous,  until  a  reasonable  time  has  been  given  the 
patient  to  procure  another  physician ;  where  his  services 
are  not  gratuitous,  he  has  no  right  to  desert  a  patient 
without  reasonable  cause  before  the  end  of  the  illness 
he  has  undertaken  to  treat. 

As  respects  voluntary  services,  Judge  Cooley  lays 
down  the  rule  thus :  "  Where  friends  and  acquaintances 
are  accustomed  to  give,  and  do  give,  to  each  other  vol- 
untary services  without  expectation  of  reward,  either 
because  other  assistance  cannot  be  procured,  or  because 
the  means  of  parties  needing  help  will  not  enable  them 
to  engage  such  as  may  be  within  reach,  the  law  will  not 
imply  an  undertaking  for  skill,  even  when  the  services 
are  such  as  professional  men  alone  are  usually  expected 
to  render.  And  where  there  is  no  undertaking  for  skill, 


MALPRACTICE.  285 

the  want  of  it  can  create  no  liability.  So  the  '  street 
opinion '  of  an  attorney,  given  in  answer  to  a  casual 
inquiry  by  one  to  whom  he  holds  no  professional  rela- 
tion, cannot,  however  erroneous,  render  him  liable. 
But  when  one  holds  himself  out  to  the  public  as  hav- 
ing professional  skill,  and  offers  his  services  to  those 
who  accept  them  on  that  supposition,  he  is  responsible 
for  want  of  the  skill  he  pretends  to,  even  when  his 
services  are  rendered  gratuitously."  Under  such  cir- 
cumstances, the  one  who  undertakes  the  treatment  of  a 
patient,  either  voluntarily  or  upon  request,  is  only  liable 
for  gross  negligence;  but  if  by  forcing  himself  into  a 
case  he  excludes  a  competent  physician,  he  is  liable  for 
slight  negligence,  or  for  lack  of  the  skill  and  diligence 
of  the  specialist.  In  general  it  may  be  said  that  the 
liability  of  one  rendering  medical  services  is  measured 
by  the  amount  of  skill  he  undertakes  to  exercise ;  and, 
as  we  have  seen,  the  matter  of  compensation  is 
immaterial. 

A  physician  must  always  use  his  best  judgment; 
and  while  he  is  not  responsible  for  mere  errors  of 
judgment  or  mere  mistakes  in  matters  of  reasonable 
doubt  and  uncertainty,  if  the  error  of  judgment  is  so 
gross  as  to  be  inconsistent  with  the  use  of  the  degree 
of  skill  required  by  the  law  he  will  be  liable  to  an 
action.  Where  errors  of  judgment  result  from  the  want 
of  ordinary  care  and  skill,  responsibility  attaches,  how- 
ever carefully  the  judgment  is  exercised.  In  exercis- 
ing his  best  judgment  the  physician  is  only  required 
to  anticipate  the  nature  and  probable  consequences  of 
his  treatment.  It  has  been  held  that  he  cannot  be 
held  responsible  for  the  disastrous  effect  resulting  from 


286  MEDICAL  JURISPRUDENCE. 

administering  chloroform  as  an  anaesthetic  to  a  patient 
of  a  peculiar  temperament  where  such  peculiarity  was 
unknown  to  him ;  but  in  view  of  the  many  fatal  cases 
resulting  from  the  use  of  chloroform,  and  the  fact  of 
the  uncertainty  of  its  action  in  this  respect,  and  the 
further  fact  that  there  are  other  efficient  anaesthetics, 
which  are  safe  as  compared  with  chloroform,  we  cannot 
see  how  at  the  present  time  a  physician  or  surgeon  can 
justify  himself  in  the  use  of  chloroform  under  ordinary 
circumstances.  We  do  not  now  refer  to  the  careful  ad- 
ministration of  chloroform  in  obstetric  cases,  nor  where 
the  patients  are  children ;  there  may  be  some  other  excep- 
tional cases  where  its  use  will  be  justified.  Its  adminis- 
tration without  a  previous  careful  physical  examination 
of  the  patient,  or  its  administration  by  a  dentist  with- 
out the  assistance  of  a  competent  physician,  and  to  a 
patient  in  an  upright  position,  seems  clearly  culpable. 
Common  prudence  would  also  require  that  neither  it  nor 
any  other  anaesthetic  should  be  administered  without 
the  aid  of  a  competent  assistant. 

A  physician  cannot  lawfully  try  experiments  upon 
his  patients  to  their  injury. 

One  who  professes  to  adhere  to  a  particular  school 
of  practice  must  come  up  to  its  average  standard,  and 
must  be  judged  by  its  tests  and  in  the  light  of  the 
present  day. 

As  to  the  mode  of  treatment  in  a  given  case,  when  it 
conforms  to  the  settled  practice  of  the  particular  school 
to  which  the  physician  belongs  he  is  relieved  from  all 
responsibility ;  in  such  case,  evidence  of  the  practice  of 
physicians  of  other  schools  is  inadmissible.  Where, 
however,  the  case  will  admit  of  but  one  mode  of  treat- 


MALPRACTICE.  287 

ment,  the  use  of  a  different  mode  would  be  evidence  tend- 
ing to  show  a  want  of  skill.  The  proper  and  only  mode, 
however,  of  showing  want  of  skill  on  the  part  of  the  de- 
fendant is  by  proving  that  he  did  not  exercise  it  in  the 
particular  case.  It  can  neither  be  established  nor  dis- 
proved by  showing  the  defendant's  general  professional 
reputation ;  it  is  improper,  therefore,  to  ask  a  witness 
what  the  reputation  of  the  physician  is  in  the  commu- 
nity and  among  the  profession  as  being  an  ordinarily 
learned  and  skilful  physician.  The  treatment  of  each 
individual  case  is  the  criterion  for  ascertaining  the  phy- 
sician's liability.  It  has  been  held,  also,  that  the  gen- 
eral opinion  of  the  practitioner  with  whom  the  physician 
studied  his  profession,  or  of  the  professors  of  the  school 
at  which  he  graduated,  are  inadmissible. 

A  sign,  or  other  proof  that  one  actually  practises 
medicine  or  surgery,  is  prima  facie  evidence  of  his  pro- 
fessional character.  The  possession  of  a  medical  diploma, 
issued  by  a  college  having  authority  to  grant  degrees  in 
medicine,  is  prima  facie  evidence  of  ordinary  skill. 

The  mere  fact  that  the  defendant  refused  consultation 
with  other  men  of  his  science  is  no  assumption  upon  his 
part  that  he  is  possessed  of  more  than  ordinary  skill ; 
and  his  declination  in  this  respect  does  not  vary  the 
application  of  any  of  the  rules  above  stated. 

As  to  the  proof  of  the  alleged  malpractice,  it  has 
been  held  that  the  limb  upon  which  the  alleged  mal- 
practice occurred  cannot  be  exhibited  to  the  jury  after 
the  lapse  of  several  years. 

It  is  the  duty  of  the  patient  to  co-operate  with  the 
physician  in  his  endeavors  to  effect  a  cure.  If  the  in- 
jury complained  of  is  due  to  the  contributory  negligence 


288  MEDICAL  JURISPRUDENCE. 

of  the  plaintiff,  no  recovery  can  be  had ;  if  the  want  of 
co-operation  of  the  plaintiff  merely  aggravates  the  effect 
of  malpractice  on  the  part  of  the  physician,  it  will 
not  debar  a  recovery,  but  will  mitigate  the  damages. 
Negligence  of  the  nurse  concurring  with  that  of  the 
physician  has  been  held  to  be  imputable  to  the  patient. 
This,  however,  would  depend  upon  the  question  whether 
such  nurse  was  the  agent  of  the  patient  or  physician. 
If  the  acts  of  negligence  can  be  so  separated  as  to  show 
that  the  injury  was  due  solely  to  the  fault  of  the  phy- 
sician, and  the  fault  of  the  nurse  was  only  remotely 
connected  therewith,  an  action  will  lie  against  the 
physician. 

A  physician  is  responsible  for  the  results  of  his 
negligence  or  unskilfulness  notwithstanding  the  case  is 
given  over  by  him  to  another ;  of  course,  however,  he 
will  not  be  responsible  for  the  subsequent  negligence  of 
the  physician  to  whom  the  case  is  transferred. 

If  a  family  doctor,  or  the  surgeon  of  a  company  or 
society,  on  leaving  home  recommends  in  case  of  need 
some  other  physician,  who  is  not,  however,  in  any  sense 
in  his  employment,  it  does  not  make  him  in  any  way 
liable  for  injuries  arising  from  the  latter's  want  of  skill. 

In  an  action  brought  by  a  father  against  two  medical 
men  to  recover  damages  for  advising  him  to  suck  a 
tracheotomy-tube  of  his  child,  who  had  just  been  oper- 
ated upon  for  diphtheria,  without  first  duly  warning  him 
of  the  risk  he  ran,  whereby  he  himself  became  infected 
with  the  disease,  it  was  held  that  there  was  no  cause  of 
action. 

The  capacity  of  the  patient  injured  to  judge  of  the 
probable  results  is  an  important  element  in  cases  of 


MALPRACTICE.  289 

malpractice ;  hence,  if  the  patient  is  insane  he  cannot 
be  chargeable  with  contributory  negligence ;  but  where 
a  patient  relies  upon  his  own  judgment,  and  not  that  of 
the  surgeon,  as  to  the  propriety  of  the  operation,  it  is 
held  that  the  surgeon  is  not  liable  for  injurious  conse- 
quences resulting  therefrom, — premising,  of  course,  that 
due  care  and  skill  are  exercised  in  performing  such 
operation. 

If  a  person  is  attacked  by  a  fatal  disease  and  there  is 
no  escape  from  it  save  by  a  dangerous  surgical  operation, 
then  if  he  gives  his  free  and  intelligent  consent  to  the 
operation  and  it  is  skilfully  performed,  the  surgeon  can- 
not be  blamed  even  though  the  patient  perishes  under 
the  knife.  If  a  woman  in  labor  is  in  such  a  condition 
that  her  life  can  be  saved  only  by  the  sacrifice  of  that 
of  the  child,  then  it  is  not  only  the  right  but  the  duty 
of  the  attendant  to  save  the  mother  at  the  expense  of 
the  child.  Of  course  in  such  a  case  counsel  should 
be  had  when  possible  before  resorting  to  such  extreme 
measures. 

The  burden  of  showing  that  the  use  of  instruments 
to  produce  abortion  was  necessary  to  save  the  life  of 
the  woman  is  on  the  defendant. 

The  rules  of  law  above  stated  respecting  the  liability 
of  physicians  for  negligence  and  malpractice  are  equally 
applicable  to  similar  charges  made  against  midwives, 
nurses,  medical  students,  chemists,  pharmacists,  and 
against  any  other  person  who  holds  himself  out  as 
possessing  special  knowledge  or  skill  in  any  particular 
department  of  learning  or  practice. 

Dentists  likewise  are  subject  to  the  same  rules  as  to 
negligence  as  physicians  and  surgeons.  A  patient  must 

19 


290  MEDICAL  JURISPRUDENCE. 

exercise  ordinary  care  and  prudence ;  so  that  if  one  tells 
a  dentist  to  pull  out  a  tooth,  but  does  not  say  which 
one  should  be  pulled,  and  the  wrong  one  is  taken  out, 
the  sufferer  has  no  legal  ground  of  complaint  unless, 
indeed,  it  is  quite  apparent  which  is  the  offending  mem- 
ber. The  patient  may  have  been  a  little  careless  and 
negligent,  still  if  the  dentist  has  been  so  very  neglect- 
ful of  his  duty  that  no  ordinary  care  on  the  part  of  the 
patient  would  have  prevented  the  mistake  or  injury 
complained  of,  the  injured  party  may  recover  damages. 
The  fact  that  one  has  taken  chloroform  will  not  affect 
his  rights  or  remedies  against  a  dentist  for  any  mistake 
or  negligence. 

The  fact  that  a  dentist  extracts  teeth  gratuitously 
does  not  relieve  him  from  liability  for  failure  to  perform 
his  work  properly. 

As  in  the  case  of  physicians  so  in  the  case  of  the 
dentist,  it  is  a  good  answer  to  an  action  to  recover 
payment  for  his  work  and  labor  that  the  defendant 
has  been  injured  instead  of  benefited  by  the  plain- 
tiffs treatment,  either  because  of  his  negligence  or 
want  of  skill. 

Sex  is  no  excuse  for  negligence,  and  there  is  no  rule 
of  law  that  less  care  is  required  of  a  woman  than  of 
a  man. 

If  a  physician  should  be  so  indiscreet  as  to  make  a 
special  contract  to  cure  a  person  of  a  certain  disease  or 
deformity  or  to  bring  about  any  other  desirable  result, 
he  will  of  course  be  liable  for  damages  for  a  breach  of 
contract  if  he  fails  to  perform  his  agreement.  Common 
prudence  would  therefore  dictate  great  caution  in  this 
respect,  and  a  guarded  prognosis  in  every  case,  lest  the 


MALPRACTICE.  291 

patient  may  pervert  what  is  intended  as  a  mere  prog- 
nosis into  a  positive  engagement  to  cure. 

Although  where  the  statute  of  a  State  requires  a  State 
license  in  order  to  authorize  a  physician  to  practise 
medicine  or  surgery  an  unlicensed  physician  cannot 
recover  at  law  compensation  for  services  rendered  by 
him,  the  fact  that  he  is  unlicensed  does  not  affect  his 
liability  to  an  action  for  malpractice. 

Although  it  may  not  afford  much  consolation  to  the 
defendant  in  a  malpractice  suit,  the  rule  of  law  is  that 
an  action  for  malpractice  does  not  survive  the  death  of 
the  defendant,  and  hence  does  not  constitute  a  claim 
against  his  estate. 

Although  it  is  not  within  the  power  of  a  State  legis- 
lature to  discriminate  in  favor  of  any  particular  school 
of  medicine,  yet  such  laws  may  be  enacted  as  will 
protect  the  people  from  ignorant  pretenders,  and  re- 
quire learning  and  skill  in  the  school  of  medicine 
which  the  physician  professes  to  practise.  No  school 
of  medicine  is  exempt  from  liability  to  an  action  for 
malpractice. 

If  a  patient  voluntarily  employs  in  one  art  a  man 
who  openly  exercises  another,  his  folly  has  no  claim  to 
indulgence.  The  old  Mahomedan  case  cited  by  Puffen- 
dorf  with  approbation  is  very  much  to  the  point :  A 
man  who  had  a  disorder  in  his  eyes  called  on  a  farrier 
for  a  remedy,  who  gave  him  one  commonly  used  upon 
his  quadrupedal  patients.  The  man  lost  his  sight  and 
brought  an  action  against  the  farrier  for  damages,  but 
the  judge  held  that  no  action  would  lie,  for  if  the  com- 
plainant had  not  himself  been  an  ass  he  would  never 
have  employed  a  horse-doctor. 


292  MEDICAL  JURISPRUDENCE. 

But  on  the  contrary  it  has  been  held  that  an  expert 
in  the  diseases  of  man  is  necessarily  an  expert  in  the 
diseases  of  animals,  so  as  to  make  his  opinion  com- 
petent evidence  upon  the  question  as  to  whether  a 
disease  with  which  a  mule  was  afflicted  was  of  recent 
origin  or  of  long  standing. 

However  much  a  regular  physician  may  differ  from  the 
method  of  treatment  adopted  by  the  profession  of  any 
other  school,  such  as  homosopathy  or  hydropathy,  these 
systems  have  acquired  a  certain  recognition  by  the  pub- 
lic, and  in  some  instances  legal  recognition  by  statute  ; 
and  it  is  not  to  be  expected  that  an  adverse  verdict  will 
be  given  merely  because  the  medical  attendant  pro 
tempore  practised  according  to  these  systems.  It  is  a 
well-known  fact  that  the  same  drugs  are  to  a  very  con- 
siderable extent  used  by  the  best  practitioners  in  the 
two  leading  schools  of  practice  ;  and  so  far  as  concerns 
the  practice  of  surgery  and  obstetrics,  the  general  prin- 
ciples of  practice  must  necessarily  be  the  same  in  every 
rational  system.  On  the  other  hand,  —  as  is  well  ob- 
served by  Drs.  Woodman  and  Tidy  in  their  manual  of 
"  Forensic  Medicine,"  —  mesmerism,  Coffinism,  Morri- 
sonism,  have  never  acquired  such  a  status,  and  are  not 
likely  to  do  so. 

Certain  other  systems  of  charlatanism  which  at  pres- 
ent are  occupying  an  undue  share  of  the  attention  of 
the  more  credulous  portion  of  the  community,  such  as 
the  so-called  "  faith  healing  "  and  "  metaphysics,"  might 
well  be  included  in  the  same  category.  It  would,  as  it 
seems  to  us,  be  very  difficult  to  frame  a  defence  to  a 
charge  of  malpractice  preferred  against  one  professing 
to  heal  certain  ailments  by  either  of  the  last  two 


MALPRACTICE.  293 

so-called  systems.  Suppose  the  case,  for  instance,  of 
the  treatment  of  strangulated  hernia,  or  a  compound 
fracture,  dislocation,  placenta  prcevia,  or  hemorrhage 
from  a  divided  artery,  by  means  of  faith  or  so-called 
metaphysics,  or  any  other  like  inefficient  means.  It 
would  not  be  possible,  in  our  judgment,  to  frame  a  de- 
fence which  would  relieve  a  party  practising  such  or 
any  other  mere  expectant  treatment  from  liability  for 
malpractice. 

As  to  the  question  of  doses,  however,  even  in  so- 
called  orthodox  medicine,  very  considerable  latitude 
within  certain  extremes  must  necessarily  be  allowed. 
Common-sense  and  experience  are  the  only  safe  criteria 
in  such  case.  As  is  well  observed,  however,  by  Drs. 
Woodman  and  Tidy,  "No  experience  and  no  theory 
can  be  held  to  justify  giving  an  infant  of  a  month  old 
£  grain  doses  of  opium  at  frequent  intervals  as  a  dental 
sedative,  or  \  grain  doses  of  strychnia  as  a  tonic." 

Several  rules  may  be  found  in  treatises  upon  therapeu- 
tics by  which  to  determine  the  dose  proper  for  patients 
under  adult  age. 

Dr.  Young's  rule  is  to  add  12  to  the  age  of  the  patient 
and  divide  the  age  by  the  sum.  Thus,  a  child  one  year 
old  would  require  -j^-,  and  one  3  years  old  ^  =  ^  of  the 
amount  necessary  for  an  adult. 

By  Dr.  Cowling's  rule  the  proportionate  dose  for  any 
age  under  adult  life  is  represented  by  the  number  of 
the  following  birthday  divided  by  24.  Thus,  for  a  child 
one  year  old  the  dose  would  be  2\  =  ^  of  that  for  an 
adult. 

Professor  Clarke's  rule  is  based  upon  relative  weights. 
Assuming  the  average  weight  of  an  adult  to  be  150  Ibs., 


294  MEDICAL  JURISPRUDENCE. 

for  whom  an  appropriate  dose  is  unity,  the  dose  of  most 
medicines  must  be  increased  or  diminished  in  the  pro- 
portion of  the  weight  of  the  patient  to  that  number  of 
pounds.  This  proportion  is  represented  by  a  fraction 
whose  numerator  is  the  patient's  weight  and  whose  de- 
nominator is  150. 

Actions  for  malpractice  are  most  frequently  brought 
where  an  unfavorable  result  has  followed  the  reduction 
of  a  fracture  or  dislocation,  or  some  other  surgical  opera- 
tion. It  would  be  interesting  to  review  the  reported 
cases  wherein  these  particular  acts  of  malpractice  are 
more  fully  discussed,  and  also  to  state  the  leading  prin- 
ciples of  the  practice  of  medicine  and  surgery  bear- 
ing upon  such  cases ;  but  the  limits  assigned  to  this 
work  forbid  entering  into  such  details.  For  further 
details  the  student  is  referred  to  "  Woodman  and 
Tidy's  Forensic  Medicine,"  and  to  the  "  Compilation 
of  Reported  Cases  upon  Civil  Malpractice  "  by  Dr.  Mc- 
Clelland, in  which  latter  book  will  be  found  a  large 
number  of  reported  cases  of  malpractice  in  the  various 
departments  of  medicine,  surgery,  obstetrics,  etc. 

2.  Criminal  Malpractice.  —  Mr.  Bishop,  in  his  work 
on  Criminal  Law,  vol.  i.,  §  314  (7th  ed.),  lays  down  the 
rule  as  to  homicide  from  carelessness  thus:  — 

"  Every  act  of  gross  carelessness,  even  in  the  perform- 
ance of  what  is  lawful,  and  a  fortiori  of  what  is  not 
lawful,  and  every  negligent  omission  of  legal  duty, 
whereby  death  ensues,  is  indictable  either  as  murder  or 
manslaughter. 

"If  a  man  take  upon  himself  an  office  or  duty  re- 
quiring skill  or  care,  —  if,  by  his  ignorance,  carelessness, 
or  negligence,  he  cause  the  death  of  another  he  will  be 


MALPRACTICE.  295 

guilty  of  manslaughter.  ...  If  a  person,  whether  a 
medical  man  or  not,  profess  to  deal  with  the  life  or 
health  of  another,  he  is  bound  to  use  competent  skill 
and  sufficient  attention ;  and  if  he  cause  the  death  of 
another  through  a  gross  want  of  either,  he  will  be  guilty 
of  manslaughter." 

In  vol.  ii.  of  his  work  on  Criminal  Law,  §  664,  Mr. 
Bishop  says :  — 

"  The  doctrine  as  to  physician  and  patient  is  not  quite 
the  same  in  England  and  the  United  States.  And  pos- 
sibly it  is  not  entirely  harmonious  among  our  States. 
According  to  English  adjudication,  whenever  one  under- 
takes to  cure  another  of  disease,  or  to  perform  on  him 
a  surgical  operation,  he  renders  himself  thereby  liable 
to  the  criminal  law  if  he  does  not  carry  to  this  duty 
some  degree  of  skill,  though  what  degree  may  not  be 
clear ;  consequently,  if  the  patient  dies  through  his 
ill-treatment,  he  is  indictable  for  manslaughter. 

"  Still,  in  an  English  case  [says  Mr.  Bishop  in  the 
same  section],  Willes,  J.,  once  put  the  doctrine  in  a 
more  reasonable  way,  thus  :  '  If  a  man  knew  that  he  was 
using  medicines  beyond  his  knowledge,  and  was  meddling 
with  things  beyond  his  reach,  that  was  culpable  rash- 
ness. Negligence  might  consist  in  using  medicines 
in  the  use  of  which  care  was  required,  and  of  the  prop- 
erties of  which  the  person  using  them  was  ignorant.  A 
person  who  so  took  a  leap  in  the  dark  in  the  adminis- 
tration of  medicine  was  guilty  of  gross  negligence.' " 
Mr.  Bishop  then  very  characteristically  and  somewhat 
dogmatically  observes  :  "  Now,  in  the  facts  of  human 
life,  the  less  a  man  understands  of  anything  occult,  like 
the  unseen  workings  of  medicine,  the  more  confident  he 


296  MEDICAL  JURISPRUDENCE. 

is  that  his  knowledge  of  the  thing  is  perfect.  There- 
fore some  of  our  American  courts  have  laid  down  the 
doctrine,  not  altogether  inharmoniously  with  this  utter- 
ance of  the  learned  English  judge,  in  substance,  that, 
since  it  is  lawful  and  commendable  for  one  to  cure  an- 
other, if  he  undertakes  this  office  in  good  faith,  and 
adopts  the  treatment  he  deems  best,  he  is  not  liable  to 
be  adjudged  a  felon,  though  the  treatment  should  be 
erroneous,  and  in  the  eyes  of  those  who  assume  to  know 
all  about  this  subject,  which  in  truth  is  understood  by 
no  mortal,  grossly  wrong;  and  though  he  is  a  person 
called  by  those  who  deem  themselves  wise,  grossly  igno- 
rant of  medicine  and  surgery."  2  Bish.  Cr.  Law,  §  664, 
citing  Commonwealth  vs.  Thompson,  6  Mass.  134 ;  and 
Rice  vs.  State,  8  Mo.  561. 

We  have  quoted  thus  largely  from  Mr.  Bishop's  ex- 
cellent book  because  we  believe  that  in  thus  dogmatiz- 
ing concerning  the  lack  of  knowledge  of  their  profession 
by  those  following  the  practice  of  medicine  and  sur- 
gery, he  has  himself  erred  through  insufficient  knowl- 
edge. "If  a  man  knew  that  lie  was  using  medicines 
beyond  his  knowledge,  and  was  meddling  with  things 
beyond  his  reach,  that  was  [indeed]  culpable  rash- 
ness." But  it  does  not  appear  that  Mr.  Justice  Willes, 
in  the  case  from  which  the  above  quotation  was  made, 
which  was  from  a  charge  to  the  jury  at  the  Durham 
Assizes,  1864,  intended  to  say  that  this  was  the  only 
kind  of  culpable  rashness.  It  seems,  on  the  other  hand, 
that  this  was  merely  an  illustration ;  for  he  immediately 
adds  :  "  Negligence  might  consist  in  using  medicines 
in  the  use  of  which  care  was  required,"  etc.  See  supra. 
That  it  was  merely  an  illustration  is  further  apparent 


MALPRACTICE.  297 

from  the  fact  that  immediately  thereafter  he  adds 
another  illustration :  "  If  a  man  were  wounded,  and 
another  applied  to  his  wound  sulphuric  acid,  or  some- 
thing which  was  of  a  dangerous  nature  and  ought  not 
to  be  applied,  and  which  led  to  fatal  results,  then  the 
person  who  applied  this  remedy  would  be  answerable, 
and  not  the  person  who  inflicted  the  wound,  because  a 
new  cause  had  intervened."  In  the  beginning  of  his 
charge  the  learned  judge  very  properly  said :  "  Every 
person  who  dealt  with  the  health  of  others  dealt  with 
their  lives,  and  every  person  who  so  dealt  was  bound 
to  use  reasonable  care  and  not  to  be  grossly  negligent 
.  .  .  Another  sort  of  gross  negligence  consisted  in  rash- 
ness, where  a  person  was  not  sufficiently  skilled  in 
dealing  with  dangerous  medicines  which  should  be  care- 
fully used,  of  the  properties  of  which  he  was  ignorant, 
or  how  to  administer  a  proper  dose.  A  person  who 
with  ignorant  rashness  and  without  skill  in  his  profes- 
sion used  such  a  dangerous  medicine  acted  with  gross 
negligence."  The  drug  given  in  this  case,  and  which 
caused  death,  was  a  tablespoonful  of  a  tincture  of  col- 
chicum-seeds,  containing  eighty  grains  of  the  seeds,  — 
eighteen  grains,  as  is  said  in  this  case,  beiug  a  fatal 
dose. 

In  Nanny  Simpson's  Case,  I  Lewin,  172,  262,  the  pris- 
oner was  indicted  for  manslaughter  in  having  caused 
the  death  of  a  man  by  administering  white  vitriol  as  a 
medicine.  Bailey,  J. :  "I  am  clear  that  if  a  person  not 
having  a  medical  education,  and  in  a  place  where  per- 
sons of  a  medical  education  might  be  obtained,  takes  on 
himself  to  administer  medicine  which  may  have  a  dan- 
gerous effect,  and  such  medicine  destroys  the  life  of  the 


298  MEDICAL  JURISPRUDENCE. 

person  to  whom  it  is  administered,  it  is  manslaughter. 
The  party  may  not  mean  to  cause  death ;  on  the  con- 
trary, he  may  mean  to  produce  beneficial  effects ;  but 
he  has  no  right  to  hazard  medicine  of  a  dangerous  ten- 
dency where  medical  assistance  can  be  obtained.  If 
he  does,  he  does  it  at  his  peril."  See  also  Tassymond's 
Case,  1  Lewin,  169,  where  the  prisoner  was  convicted 
of  manslaughter  in  causing  the  death  of  an  infant  by 
negligently  selling  laudanum  for  paregoric. 

It  may  be  conceded  that  the  cases  of  Commonwealth 
vs.  Thompson,  6  Mass.  134  (decided  in  1809),  and  Rice 
vs.  State,  8  Mo.  561  (decided  in  1844),  —  in  the  former  of 
which  the  law  of  the  case  is  contained  in  Chief  Justice 
Parsons's  charge  to  the  jury  that  tried  the  prisoner,  and 
the  latter  of  which  is  apparently  decided  mainly  upon 
the  authority  of  the  former,  —  seem  to  lay  down  the  rule 
that  in  order  to  warrant  a  conviction  for  murder  or 
manslaughter,  the  defendant  must  have  some  knowledge 
of  the  fatal  tendency  of  the  prescription.  An  attentive 
perusal  of  these  cases  cannot  fail,  as  it  seems  to  us,  to 
convince  the  reader  that  there  was  a  palpable  failure  of 
justice  in  both  cases. 

In  the  case  of  Commonwealth  vs.  Thompson  the 
defendant  gave  to  the  patient  suffering  with  a  cold, 
powdered  lobelia,  and  persisted  in  giving  it  to  him 
for  a  period  of  eight  days  till  he  was  so  completely 
exhausted  that  no  relief  could  be  afforded,  and  he  died 
of  exhaustion. 

In  Eice  vs.  The  State  the  defendant  in  the  court  below 
was  employed  by  the  husband  of  a  woman  near  the 
end  of  the  eighth  month  of  pregnancy,  to  cure  her  of 
"  sciatica ; "  and  after  having  been  informed  of  her  con- 


MALPRACTICE.  299 

dition  and  that  other  physicians  had  cautioned  against 
the  use  of  vapor  baths  and  emetics  in  her  then  condi- 
tion, he  commenced  a  course  of  treatment  by  steaming 
and  giving  lobelia,  and  persisted  in  this  treatment  till 
she  had  a  premature  delivery,  a  few  days  after  which 
she  died.  The  evidence  showed  that  she  had  been 
married  five  years,  and  during  that  time  had  had  three 
children,  always  doing  well  after  a  confinement,  and 
was  in  better  health  when  the  defendant  commenced 
his  practice  on  her  than  she  had  been  for  many  years. 

After  a  consideration  of  the  reported  cases  it  seems 
to  the  writer  that  the  cases  of  Commonwealth  vs.  Tlwmp- 
son  and  Rice  vs.  The  State  are  clearly  wrong.  In  our 
opinion  the  rule  laid  down  in  the  late  case  of  Com- 
monwealth vs.  Pierce,  decided  by  the  Supreme  Court  of 
Massachusetts,  is  much  more  rational,  and  virtually 
overrules  the  rule  laid  down  in  Commonwealth  vs. 
Thompson.  In  Commonwealth  vs.  Pierce  it  was  held  — 
Holmes,  J.,  delivered  the  unanimous  opinion  of  the 
Court  —  that  to  constitute  manslaughter  where  there  is 
no  evil  intent,  it  is  not  necessary  that  the  killing  should 
be  the  result  of  an  unlawful  act ;  it  is  sufficient  if  it  is 
the  result  of  reckless  or  foolhardy  presumption  judged 
by  the  standard  of  what  would  be  reckless  in  a  man  of 
ordinary  prudence  under  the  same  circumstances. 

The  defendant  in  this  case,  who  publicly  practised  as 
a  physician,  being  called  upon  to  attend  a  sick  woman, 
caused  her  with  her  consent  to  be  kept  in  flannels  satu- 
rated with  kerosene  for  three  days,  by  reason  of  which 
she  died.  There  was  evidence  that  he  had  made  simi- 
lar applications  with  favorable  results  in  other  cases, 
but  that  in  one  the  effect  had  been  to  blister  and  bum 


300  MEDICAL  JURISPRUDENCE. 

the  flesh,  as  in  the  present  case.  It  was  held  that  the 
jury  having  found  that  the  application  was  made  as  the 
result  of  foolhardy  presumption  or  gross  negligence,  a 
conviction  of  manslaughter  was  proper. 

The  court  in  the  case  of  Commonwealth  vs.  Pierce 
has  carefully  limited  the  application  of  the  rule  there 
laid  down  to  cases  where  there  was  no  sudden  emer- 
gency and  where  no  exceptional  circumstances  were 
shown ;  and  thus  limited,  the  rule  of  the  case  seems 
eminently  reasonable  and  grounded  on  the  soundest 
views  of  public  policy. 


CHAPTER  XX. 

GENERAL  TOXICOLOGY. 

Toxicology  treats  of  the  history  and  properties  of 
poisons  and  their  effect  upon  the  living  body.  Although 
this  subject  is  commonly  treated  as  a  part  of  medical 
jurisprudence,  it  has  practically  become  a  distinct  sci- 
ence ;  and  at  least  so  far  as  concerns  the  chemical  an- 
alysis of  the  stomach  or  other  viscus  for  the  detection 
of  poison,  he  would  indeed  be  a  bold  if  not  reckless 
man  who  would  undertake  to  conduct  such  analysis  for 
medico-legal  purposes  without  special  technical  train- 
ing greater  than  is  possessed  by  the  average  medical 
practitioner. 

The  growth  of  the  science  and  the  number  and  im- 
portance of  the  facts  connected  therewith  are  so  great 
as  to  demand  more  time  and  attention  in  order  to  render 
one  expert  than  can  be  devoted  to  the  subject  by  a 
medical  practitioner.  We  have  thought  it  best,  there- 
fore, to  include  in  this  volume  only  the  subject  of 
general  toxicology,  by  which  we  mean  such  considera- 
tion of  the  subject  as  is  necessary  to  enable  a  medical 
practitioner,  who  usually  is  the  first  to  have  knowledge 
of  the  facts  in  any  alleged  case  of  poisoning,  to  so 
conduct  the  preliminary  examination  that  the  subse- 
quent and  more  particular  chemical  examination  by  an 


302  MEDICAL  JURISPRUDENCE. 

expert  chemist  may  not  be  vitiated  by  the  negligence 
or  ignorance  of  those  who  have  preceded  him.  It  would 
be  better,  perhaps,  if  both  the  preliminary  inspection 
and  the  subsequent  chemical  analysis  could  be  con- 
ducted by  one  and  the  same  person ;  but  considering  the 
magnitude  of  the  subject,  and  the  tendency  to  speciali- 
zation which  exists  at  the  present  time,  this  is  perhaps 
not  to  be  expected. 

From  the  definition  of  toxicology  above  given  it  is 
evident  that  a  correct  understanding  of  the  subject  will 
involve  an  intimate  acquaintance  not  only  with  the 
science  of  chemistry,  but  also  with  materia  medica, 
semiology,  physiology,  therapeutics,  and  pathology.  It 
will  also  at  times  include  within  its  scope  the  exami- 
nation and  investigation  of  fictitious  or  adulterated 
articles,  medicines,  food,  drink,  pigments  on  walls,  dyes 
on  clothing,  etc. 

Notwithstanding  the  immense  accumulation  of  learn- 
ing upon  the  subjects  above  mentioned,  it  must  be  con- 
fessed that,  in  not  a  few  instances,  it  is  very  difficult  if 
not  impossible  to  discriminate  with  certainty  during  life 
between  poisoning  and  ordinary  disease ;  and  in  an  equal 
number  of  cases  it  will  be  found  that  the  inspector  is 
also  incapable  of  laying  down  any  characteristic  distinc- 
tions between  the  appearances  left  in  a  dead  body  by 
certain  diseases  and  those  which  result  from  the  action 
of  poison  on  the  tissues.  Moreover,  when  we  come  to 
the  evidence  derived  from  chemical  analysis,  it  will  be 
found  in  the  case  of  the  organic  poisons  that,  in  the 
present  state  of  our  knowledge  (or  rather  ignorance),  it  is 
impossible  thus  to  determine  the  existence  in  the  body 
of  some  such  poisons. 


GENERAL  TOXICOLOGY.  303 

The  subject  of  ptomaines,  or  certain  basic  bodies 
developed  during  putrefactive  decomposition  of  animal 
substances,  moreover,  opens  up  a  new  field  of  investiga- 
tion, and  one  which  has  thus  far  been  comparatively  little 
cultivated.  Certain  poisonous  principles  have  also  been 
found  in  certain  pathological  conditions  of  the  body, 
and  even  according  to  some  observers,  in  normal  tissues 
and  secretions,  the  exact  conditions  of  the  development 
of  which  do  not  appear  to  have  yet  been  determined. 

Again,  the  subject  of  bacteriology  probably  has  an 
intimate  connection  with  the  subject  under  consid- 
eration, and  notwithstanding  the  infancy  of  this  sci- 
ence there  is  already  a  vast  accumulation  of  learning 
and  research  upon  the  subject.  Indeed,  with  reference 
to  any  one  of  these  subjects  the  field  is  sufficiently 
broad  to  occupy  the  best  part  of  an  ordinary  life-time ; 
so  that,  repeating  what  we  have  said  before,  we  feel 
fully  justified  in  this  connection  in  confining  ourselves 
to  preliminary  considerations,  and  not  entering  upon 
the  subject  of  chemical  analysis. 

A  poison  is  defined  by  Dr.  Wormley,  in  his  work 
upon  the  "Micro-Chemistry  of  Poison,"  as  "any  sub- 
stance which,  when  taken  into  the  body  and  either  being 
absorbed,  or  by  its  direct  chemical  action  upon  the  parts 
with  which  in  contact,  or  when  applied  externally  and 
entering  the  circulation,  is  capable  of  producing  deleteri- 
ous effects." 

Dr.  Taylor  defines  a  poison  as  "  a  substance  which, 
when  absorbed  into  the  blood,  is  capable  of  seriously 
affecting  the  health  or  of  destroying  life."  This  defini- 
tion does  not  seem  sufficiently  comprehensive,  and  we 
prefer  the  definition  of  Dr.  Wormley.  The  legal  scope 


304  MEDICAL  JURISPRUDENCE. 

of  the  statutes  against  poisoning  is  not  unfrequently 
enlarged  by  the  use  of  other  terms,  such  as  "other  de- 
structive or  noxious  thing;"  but  the  definition  above 
quoted  from  Wormley  is  believed  to  be  medically 
correct. 

When  the  suspicion  of  poison's  having  been  admin- 
istered arises  upon  any  occasion,  the  services  of  a  medi- 
cal practitioner  or  medical  jurist  may  be  called  for  under 
a  variety  of  circumstances.  A  medical  practitioner  may 
be  called  upon  to  treat  the  party  during  life ;  to  inspect 
the  body  after  death ;  to  testify  upon  the  preliminary 
examination  or  upon  the  trial  of  the  indictment,  or 
upon  both  these  occasions.  In  order  to  qualify  him  to 
act  in  these  important  relations,  it  is  necessary  that  he 
should  possess  a  most  intimate  acquaintance  with  the 
effect  of  a  large  majority  of  known  poisons,  and  also 
with  the  course  and  termination  of  acute  and  chronic 
diseases  generally. 

Although  the  most  satisfactory  evidence  of  poisoning 
consists  in  the  isolation  of  some  particular  poison  from 
the  tissues,  or  tissue  secretions,  or  matter  ejected  from 
the  body,  there  are  some  instances  in  which  the  medical 
probability  of  poisoning  may,  in  conjunction  with  other 
circumstances  of  general  evidence,  raise  so  high  a  prob- 
ability of  poisoning  that  there  can  be  little  room  for 
doubt,  even  though  the  particular  poison  has  not  been 
isolated. 

It  will  of  course  be  impossible  in  the  scope  of  this 
manual  to  present  anything  like  even  an  outline  of  the 
collateral  sciences  a  knowledge  of  which  is  necessary  to 
the  full  understanding  of  the  subject  under  considera- 
tion. The  student  is  referred  for  further  particulars 


GENERAL  TOXICOLOGY.  305 

upon  these  important  subjects  to  the  general  treatises 
upon  Practice  of  Medicine,  Materia  Medica,  Therapeu- 
tics, Pathology,  etc. 

In  this  connection,  however,  certain  things  may  be 
touched  upon  which  more  particularly  appertain  to  this 
subject,  —  such  as  the  channels  of  entrance  and  mode 
of  action  of  poisons,  etc. 

The  channels  of  entrance  of  a  poison  into  the  human 
body  may  be  thus  enumerated :  1.  The  blood  vessels, 
including  wounds.  2.  The  skin  and  cellular  membranes. 
3.  The  air  passages  and  lungs.  4.  The  stomach. 
5.  The  intestines. 

In  this  connection  it  may  be  well,  perhaps,  to  specify 
the  channels  of  exit  by  which  poisons  are  eliminated 
or  excreted  from  the  body,  and  the  organs  and  tissues 
in  which  they  undergo  an  intermediate  deposit.  The 
channels  of  exit  are:  1.  The  urine.  2.  The  bile.  3. 
The  milk.  4.  The  saliva.  5.  Mucous  secretions.  6. 
Serous  secretions.  7.  The  perspiratory  fluid. 

The  organs  or  tissues  where  they  undergo  intermedi- 
ate deposit  are :  1.  The  liver.  2.  The  kidneys.  3.  The 
spleen.  4.  The  heart.  5.  The  lungs.  6.  The  muscles. 
7.  The  brain.  8.  The  fat.  9.  The  bones. 

For  further  information  upon  these  subjects,  the 
student  is  referred  to  Wood's  and  Bartholow's  excellent 
treatises  upon  Materia  Medica  and  Therapeutics. 

With  respect  to  most  poisons,  their  entrance  into  the 
blood,  as  the  result  of  absorption  or  injection,  is  a  con- 
dition necessary  to  their  action.  Strychnia  or  prussic 
acid,  applied  directly  to  the  brain,  spinal  marrow,  or 
nerves,  produces  no  effect,  or  only  a  slight  local  action 
after  some  time ;  but  when  a  portion  of  either  of  these 

20 


306  MEDICAL  JURISPRUDENCE. 

poisons  is  carried  by  absorption  into  the  arterial  capil- 
lary system  symptoms  of  poisoning  appear.  Using, 
however,  the  term  "poison  "  in  the  broader  sense  in  which 
it  is  above  defined,  there  appear  to  be  some  substances 
in  poisoning  with  which  death  is  caused  by  local  chemi- 
cal changes ;  the  mineral  acids  and  caustic  alkalies  con- 
stitute the  principal  poisons  producing  this  direct  local 
chemical  effect. 

Action  of  Poisons.  —  The  greater  portion  of  our 
knowledge  as  respects  the  action  of  different  poisons  is 
derived  from  empirical  sources,  such  as  observation  of 
the  symptoms  caused  by  them  in  the  living,  and  the 
morbid  traces  left  by  them  on  the  dead  body.  A  few 
poisons  destroy  the  tissues  with  which  they  come  into 
immediate  contact ;  a  larger  number  irritate  and  inflame 
the  part  reached  by  them ;  a  limited  number  act  injuri- 
ously on  the  brain  or  spinal  cord,  or  both,  or  on  both 
the  brain  and  the  heart;  while  a  large  proportion  of  poi- 
sonous articles  act  either  simultaneously  or  successively 
both  on  the  mucous  surfaces  and  on  the  cerebro-spinal 
system ;  on  the  former  as  irritants,  on  the  latter  either 
as  stimulants  or  sedatives.  Some  poisons  have  a  direct 
action  on  the  organ  or  organs  to  which  they  are  applied, 
and  an  indirect  action  on  the  system  generally,  or  on 
some  one  or  more  of  its  remote  organs.  It  is  only  in 
the  case  of  concentrated  mineral  acids,  and  a  few  of  the 
more  powerful  irritants,  that  the  local  action  is  suffi- 
ciently powerful  to  destroy  life.  What  was  once  con- 
sidered as  the  purely  local  effects  of  different  poisons 
is  now  known  to  be  equally  producible  whether  the 
poison  in  question  has  been  directly  applied  to  the 
organ  affected,  or  has  reached  it  through  the  circulation. 


GENERAL  TOXICOLOGY.  307 

Arsenic,  for  instance,  exerts  its  irritant  action  on  the 
intestinal  canal  equally  when  swallowed,  when  applied 
to  a  wound,  or  when  introduced  into  the  veins  by 
injection. 

Certain  poisons  have  an  unquestionable  affinity  for 
particular  viscera ;  thus,  opium,  chloroform,  and  chloral 
hydrate  act  on  the  cerebro-spinal  system ;  strychnia  on 
the  spinal  cord,  etc.  Such  special  actions  are  not,  how- 
ever, always  witnessed  on  the  organ  for  which  they 
have  a  special  affinity,  and  they  are  variably  influenced 
by  dose,  mode  of  administration,  constitutional  peculi- 
arities, and  proclivity  to  morbid  action,  or  the  reverse, 
in  the  system.  Certain  poisons,  without  doubt,  undergo 
changes  within  the  body  after  their  absorption  and  prior 
to  their  elimination.  The  mineral  acids  combine  with 
alkalies,  the  vegetable  acids  are  in  some  cases  decom- 
posed, in  others  eliminated  unchanged,  and  in  others 
enter  into  combination  with  the  alkalies  of  the  body. 

The  action  of  poisons  is  modified  by  a  variety  of  cir- 
cumstances, such  as :  1.  Quantity  of  dose.  2.  Form  in 
which  the  poison  is  administered.  3.  Chemical  action. 
4.  The  tissues  directly  acted  upon.  5.  Habit.  6.  Idio- 
syncrasy. 

1.  Quantity  of  Dose.  —  There  are  great  differences 
among  different  drugs  as  respects  the  amount  necessary 
to  be  taken  to  produce  deleterious  effects.  There  are 
few  poisons  which  are  not  harmless  in  small  doses,  while 
many  of  them  in  moderate  doses  are  medicinal.  Some 
are  so  active  that  they  can  only  be  administered  with 
safety  in  very  small  quantities,  —  such  as  strychnia,  conia, 
veratria,  aconitine,  prussic  acid,  etc.  Other  poisons  are 
injurious  only  when  taken  in  very  large  doses,  —  such 


308  MEDICAL  JURISPRUDENCE. 

as  alum,  sulphate  of  potash,  cream  of  tartar,  etc.  Oue 
fiftieth  of  a  grain  of  aconitine  has  produced  alarm- 
ing results  to  an  adult ;  while  an  ounce  of  magnesium 
sulphate  can  generally  be  administered  without  dan- 
ger, although  in  large  quantities  it  has  several  times 
caused  death. 

In  some  instances  the  largeness  of  a  dose  of  poison 
may  save  the  patient  by  producing  speedy  and  copious 
vomiting,  leaving  only  irritability  of  the  stomach  for  a 
few  days. 

Some  poisons  act  on  different  parts  of  the  system 
according  to  the  amount  of  the  dose. 

2.  Form  in  which  the  Poison  is  Administered.  —  The 
form  in  which  the  poison  is  administered  has  great  in- 
fluence upon  its  action.     Some  poisons  require  to  be 
dissolved  before  they  can  produce  their  characteristic 
effect ;  others  act  most  energetically  in  a  state  of  vapor, 
such  as  chloroform  or  ether  ;  others,  again,  are  weakened 
in  their  effect  by  admixture  and  dilution,  although  this 
rule  is  not  universal. 

3.  Chemical  State.  — The  chemical  state  of  the  poison 
materially  affects  its  results ;  some  substances  cease  to 
be  poisonous  when  neutralized,  while  neutralization  ren- 
ders others  more  energetic ;  others,  again,  are  not  affected 
by  neutralization  provided  the   compound  is  soluble. 
Generally  the  effects  of  a  base  are  little  influenced  by 
the  acid  with  which  it  combines ;  and  the  same  rule  gen- 
erally holds  true  as  to   acids,  such  as  prussic,  oxalic, 
arsenious,  and  arsenic  acids.     Salts  which  are  isomor- 
phous  are  closely  allied  in  action. 

4.  The  Tissues  directly  Acted  upon.  —  The  tissue  acted 
upon  by  the  poison  influences  the  results.   The  unbroken 


GENERAL  TOXICOLOGY.  309 

skin  is  insensible  to  the  action  of  most  poisons  un- 
less when  applied  in  a  state  of  gas  or  vapor,  or  assisted 
by  friction.  Many  medicines  may,  however,  be  intro- 
duced into  the  system  by  inunction.  The  action  of  poi- 
sons introduced  into  the  veins  is  very  rapid  and  energetic, 
as  is  also  their  action  when  brought  into  contact  with 
the  air-cells  of  the  lungs ;  next  follow  serous  surfaces, 
and  lastly,  mucous  membranes. 

Certain  vegetable  poisons  which  are  very  powerful 
when  applied  directly  to  the  wound,  may  be  swallowed 
with  impunity. 

5.  Habit.  —  Habit  has  great  influence  in  modifying  the 
effect  of  certain  poisons.  Its  effect  is  most  striking  in 
the  case  of  opium  and  alcohol.  Dr.  Ogstou,  from  whose 
excellent  work  we  abridge  the  principal  part  of  this  chap- 
ter, states  that  he  has  known  a  quart  of  laudanum  being 
consumed  in  a  few  weeks  by  an  opium-eater,  although 
this  was  not  done  with  ultimate  impunity.  He  states 
that  habit  has  no  effect  in  mitigating  the  action  of  inor- 
ganic poisons,  and  says  that  notwithstanding  the  alleged 
facts  which  have  been  brought  forward  in  proof  of  what 
is  termed  the  tolerance  of  increasing  doses  of  certain  of 
these,  —  such  as  arsenic,  tartar  emetic,  and  sulphate  of 
copper,  —  the  truth  seems  to  be  that  beyond  certain 
limits,  undoubtedly  pretty  wide  in  the  case  of  arsenic, 
the  system  in  the  use  of  these  poisons  becomes  more 
and  more  instead  of  less  and  less  susceptible  to  the  same 
doses  where  their  administration  has  been  continued  for 
any  length  of  time  and  in  quantities  at  all  considerable. 
On  the  other  hand,  Dr.  Wormley  regards  as  authentic 
the  accounts  of  the  Styrian  arsenic-eaters  published  by 
Dr.  Roscoe,  but  states  that  the  experience  of  most  medi- 


310  MEDICAL  JURISPRUDENCE. 

cal  practitioners  in  the  use  of  this  drug  does  not  accord 
with  the  results  of  this  Styrian  practice. 

In  certain  pathological  conditions  of  the  body  there 
is  an  increased  susceptibility  to  the  action  of  some  drugs 
and  a  diminished  sensibility  to  others.  In  delirium  tre- 
mens,  hydrophobia,  tetanus,  mania,  or  peritonitis,  quanti- 
ties of  opium  are  beneficial  which  in  health  would  be 
highly  dangerous,  if  not  fatal.  On  the  other  hand,  where 
a  predisposition  to  apoplexy  exists,  an  ordinary  dose  of 
opium  may  cause  death. 

6.  Idiosyncrasy.  —  Idiosyncrasy  shows  itself  in  an 
unusual  susceptibility  in  some  persons  to  the  action  of 
certain  drugs  in  medicinal  doses,  or  even  in  very  small 
quantities.  In  some  persons  common  articles  of  food  or 
drink  may  produce  symptoms  of  irritant  poisoning.  Dr. 
Ogston  records  one  case  in  his  practice  in  which  opium 
in  any  shape  or  dose  caused  distressing  nervous  irrita- 
tion ;  a  second  in  which  it  led  to  erythema,  and  a  third 
in  which  it  brought  on  diarrhea.  Other  interesting 
instances  will  be  found  narrated  by  the  same  author  and 
by  other  writers  upon  this  subject. 

Evidence  of  Poisoning.  —  1.  Suddenness  of  onset  of 
the  symptoms  in  a  healthy  person  soon  after  partak- 
ing some  liquid  or  solid  usually  awakens  suspicion  of 
poisoning.  This  criterion  is  not  usually  a  safe  one,  for 
the  reason,  as  medical  men  well  know,  that  there  are 
many  diseases  whose  onset  is  sudden  and  whose  course 
is  rapid ;  taken  in  connection,  however,  with  other  symp- 
toms, these  indications  are  of  value.  The  time  within 
which  a  poison  takes  effect  after  its  administration, 
varies  in  different  cases, — the  action  in  some  cases  tak- 
ing place  either  immediately  or  within  a  short  time,  and 


GENERAL  TOXICOLOGY.  311 

in  others  the  symptoms  being  delayed  an  hour  or  even 
several  hours.  When  several  persons  have  partaken  of 
the  same  liquid  or  solid  and  are  all  suddenly  attacked  in 
the  same  manner,  this  of  course  raises  a  much  stronger 
presumption  of  poisoning. 

2.  In  cases  of  poisoning,  the  symptoms  usually 
rapidly  run  their  course,  their  duration,  however,  being 
subject,  even  in  the  same  drug,  to  considerable  variation. 
A  few  poisons,  notably  prussic  acid,  very  rapidly  pro- 
duce a  fatal  termination,  although  even  in  the  case  of 
hydrocyanic  acid  there  are  recorded  instances  in  which 
death  has  not  occurred  until  the  lapse  of  several 
hours. 

It  should  be  remembered  in  this  connection  that  there 
are  certain  diseases  whose  symptoms  resemble  irritant 
poisoning,  such  as  cholera,  inflammation  of  the  stomach 
and  bowels,  and  perforation  of  the  stomach ;  and  that 
the  symptoms  of  other  diseases  may  resemble  narcotic 
poisoning,  as  in  the  case  of  apoplexy,  inflammation  of  the 
brain,  etc.  In  such  cases  the  true  cause  of  death  may 
in  some  instances  be  discovered  by  the  post-mortem  in- 
spection, while  in  others,  there  may  be  no  characteristic 
morbid  appearances. 

Although,  as  above  stated,  symptoms  resembling 
poisoning  are  not  a  safe  criterion  in  many  cases,  still 
there  are  some  cases  in  which  alone  they  afford  very 
strong  evidence  thereof;  thus  in  the  case  of  strychnia 
and  oxalic  acid  it  is  conceded  by  Christison  that  there 
are  no  natural  diseases  which  successfully  simulate  the 
effects  of  these  poisons,  and  if  it  should  happen  that 
several  persons  who  have  partaken  together  of  the  same 
articles  of  food,  drink,  or  medicine,  have  been  simul- 


312  MEDICAL  JURISPRUDENCE. 

taneously  attacked  with  similar  symptoms,  the  evidence 
would  amount  almost  to  demonstration. 

In  some  instances  also  very  strong  evidence  may  be 
derived  from  the  condition  of  the  lips  and  mouth,  the 
impending  suffocation  from  closure  of  the  larynx,  coldness 
of  the  surface  and  depression  of  the  heart's  action,  together 
with  acid  stains  upon  the  lips,  mouth,  and  clothes ;  and 
although  the  evidence  from  the  symptoms  except  in  a 
few  instances,  may  be  short  of  actual  proof  of  the  ad- 
ministration of  poison,  they  always  constitute  important 
confirmatory  evidence.  It  is  to  be  remembered,  how- 
ever, as  stated  by  Christison,  that  it  does  not  follow  be- 
cause a  poison  has  been  given  that  it  has  been  the 
cause  of  death ;  hence,  in  every  medico-legal  inquiry 
the  cause  of  the  first  symptoms  and  the  cause  of  the 
death  should  be  made  two  distinct  questions. 

3.  Evidence  of  Poisoning  deducible  from  the  Post- 
mortem. —  The  evidence  from  this  source  is  either  nega- 
tive or  positive.  No  reliance  is  to  be  placed  on  such 
appearances  in  the  dead  body  as  unusual  lividities  or  its 
rapid  decomposition ;  and  it  is  believed  that  except  in  a 
very  few  particular  instances  the  morbid  appearances 
left  by  poison  upon  the  corpse  do  not  differ  specifically 
from  those  following  natural  diseases  or  some  other 
kinds  of  violent  death.  The  entire  absence  of  those 
morbid  appearances  on  the  body  which  are  indicative 
of  the  action  of  poisons,  even  if  conjoined  with  the  pres- 
ence of  those  which  result  from  disease  to  an  extent 
sufficient  to  account  for  death  from  natural  causes,  will 
not  always  suffice  to  negative  the  possibility  of  poison 
having  been  administered.  In  such  a  case,  however, 
it  will  be  very  difficult  if  not  impossible  to  secure  a 


GENERAL  TOXICOLOGY.  313 

conviction  of  poisoning.  The  only  chance  of  the  truth's 
being  brought  to  light  in  such  a  case  is  where  the 
symptoms  and  appearances  produced  by  the  disease  are 
widely  different  from  those  caused  by  the  poison  alleged 
to  have  been  taken. 

In  order  properly  to  make  a  post-mortem  inspection  in 
a  case  of  suspected  poisoning,  the  examiner  should  be 
well  versed  in  pathology  and  should  be  especially  familiar 
with  the  numerous  changes  which  may  simulate  the 
appearances  due  to  the  administration  of  poison  during 
life ;  thus,  while  he  should  expect  evidence  of  irrita- 
tion, inflammation,  or  corrosion  of  parts  of  the  alimen- 
tary canal  after  the  ingestion  of  several  of  the  irritant 
poisons,  he  must  remember  that  all  these  may  have 
arisen  from  natural  causes.  Thus  the  stomach  of 
drunkards  is  sometimes  found  to  be  intensely  red,  or 
what  is  more  common,  reddening  on  exposure  to  the 
air.  Appearances  of  superficial  inflammation  or  even 
ulceration  are  sometimes  encountered  in  the  mouth, 
throat,  and  stomach  of  new-born  infants,  all  of  intra- 
uterine  origin.  Again,  decomposition  may  cause  red- 
ness of  the  stomach;  and  in  some  cases  of  sudden 
death,  as  in  executed  criminals,  the  stomach  has  been 
found  highly  vascular  where  no  symptoms  of  irritation 
or  inflammation  existed  during  life.  Severe  inflamma- 
tion or  ulceration  in  the  mouth,  throat  or  oesophagus 
observed  in  the  dead  body,  are  much  more  likely  to 
have  been  the  consequence  of  previous  disease  than  of 
any  irritant  or  corrosive  poison.  Corrosions  of  the  stom- 
ach or  smaller  intestines  from  the  action  of  poisons  of 
this  class  will  scarcely  be  confounded  by  a  competent 
observer  with  ulcerations  caused  by  disease. 


314  MEDICAL  JURISPRUDENCE. 

Softening  of  the  coats  of  the  stomach  is  common  both 
to  disease  arid  to  the  action  of  corrosive  poisons ;  such 
softening  has  been  known  in  a  few  instances  of  sudden 
death  to  be  caused  by  the  solvent  action  of  the  gastric 
juice  on  the  coats  of  the  stomach  after  death,  or  it  may 
present  itself  as  an  example  of  the  disease  termed  gelat- 
iniform  softening ;  in  both  cases  the  tissues  are  com- 
pletely disorganized  and  usually  broken  up  into  shreds 
over  a  considerable  portion  of  the  organ.  In  such  cases 
the  examiner  should  not  attribute  the  appearance  in 
question  to  any  corrosive  poison  unless  the  poison  is 
actually  found  in  the  stomach. 

Rounded  perforations  of  small  size  in  certain  un- 
healthy states  of  the  stomach  and  smaller  intestines 
sometimes  destroy  life  in  a  few  hours,  preceded  by 
symptoms  not  unlike  the  effect  of  irritant  poisoning ; 
the  symptoms  where  death  occurs  in  such  cases  are 
generally  clearly  due  to  peritonitis,  while  the  edges  of 
the  perforations  are  rounded,  thickened,  and  of  almost 
cartilaginous  hardness. 

In  many  of  the  deaths  from  narcotic  and  iiarcotico- 
acrid  poisoning,  the  inspection  of  the  body  affords  no 
evidence,  either  the  appearances  being  such  as  are 
common  to  other  cases  of  death,  or  there  being  no  traces 
whatever  of  morbid  action  in  the  body ;  this  last  may 
happen  even  with  some  of  the  irritant  poisons. 

Putrefaction  in  the  dead  body  may  obliterate  the 
traces  of  a  large  number  of  those  poisons  which  produce 
marked  changes  in  the  fresh  corpse. 

Some  poisons,  however,  leave  traces  of  their  morbid 
action  which  are  not  easily  obliterated  ;  such  as  intense 
phlogosis  in  the  upper  part  of  the  alimentary  canal  from 


GENERAL  TOXICOLOGY.  315 

certain  of  the  irritants,  and  the  destruction  of  its  coats 
and  even  perforation  of  the  tube  by  the  more  powerful 
escharotics,  as  well  as  the  less  marked  effect  on  the  skin, 
throat,  or  oesophagus  by  some  of  the  mineral  acids.  It 
is,  however,  in  connection  with  the  symptoms  and  the 
general  evidence  that  the  morbid  appearances  after 
death  furnish  distinctive  proof  of  poisoning. 

Method  of  Making  the  Autopsy.  —  Inasmuch  as  the 
post-mortem  will  nearly  always  be  conducted  by  a 
medical  practitioner,  and  not  by  the  chemist  who  makes 
the  analysis,  it  is  important  that  due  care  should  be 
taken  by  the  practitioner  in  making  such  examination, 
in  order  that  the  results  of  the  chemical  analysis  may 
not  be  invalidated  by  the  preceding  negligence  or  igno- 
rance of  the  party  who  made  the  post-mortem.  The 
importance  of  this  part  of  the  examination  can  scarcely 
be  over-estimated.  The  general  method  of  making  a 
medico-legal  inspection  has  already  been  sufficiently 
treated  in  a  preceding  chapter ;  the  attention  of  the 
reader  will  therefore  here  only  be  directed  to  some 
general  considerations  of  importance  in  addition  to  those 
already  given. 

In  inspecting  the  body  of  a  person  suspected  to  have 
been  poisoned,  it  is  of  the  utmost  importance  for  the 
examiner  before  commencing  his  examination  to  be  in 
possession  of  all  the  authentic  information  which  can 
be  procured  regarding  the  previous  history  of  the  case. 
Such  information  is  of  importance  at  the  inspection,  as 
leading  the  inspector  to  attend  particularly  to  the  state 
of  those  organs  which  are  most  usually  affected  by  the 
individual  poison  suspected  to  have  been  administered, 
and  may  prevent  his  overlooking  points  and  circum- 


316  MEDICAL  JURISPRUDENCE. 

stances  to  which  otherwise  his  search  and  observation 
might  not  have  extended. 

Before  proceeding  to  the  inspection,  the  examiner 
should  provide  himself  with  ligatures,  distilled  water, 
and  vessels  for  containing  the  stomach,  the  intestines, 
and  any  matters  which  may  have  been  vomited  ;  if  this 
has  not  already  been  done,  all  suspected  articles  whether 
food,  drink,  or  medicines,  which  may  be  found  in  the 
apartments  of  the  deceased  should  be  collected  and  care- 
fully sealed  up  for  future  examination.  If  any  sub- 
stances have  been  spilt  on  the  floor,  a  new  or  carefully 
washed  sponge  or  clean  cloth  should  be  used  to  wipe 
them  up,  when  they  may  be  preserved  in  separate  ves- 
sels. If  the  deceased  has  vomited,  the  vomited  mat- 
ters, especially  those  first  ejected,  should  be  preserved 
and  their  quantity,  odor,  color,  and  acid  or  alkaline  re- 
action noted.  If  the  vomiting  has  taken  place  on 
articles  of  dress  or  on  the  floor  or  furniture  of  the  room, 
the  stained  portion  of  the  clothing,  sheet,  or  carpet 
should  be  cut  out  and  preserved  for  analysis.  If  the 
vomiting  occurred  on  a  wooden  floor,  a  portion  of  the 
wood  may  be  scraped  off  or  cut  out ;  if  upon  a  stone 
pavement,  a  clean  piece  of  cloth  or  sponge  soaked  in 
distilled  water  should  be  used  to  remove  any  traces  of 
the  substance. 

The  vessels  in  which  vomited  matters  were  contained 
will  sometimes  present  valuable  evidence,  since  heavy 
mineral  poisons  fall  to  the  bottom  or  adhere  to  the  sides 
of  the  vessel. 

When  the  vomited  substance  consists  of  animal  mat- 
ters liable  to  putrefaction  it  has  been  advised  that  they 
be  kept  in  alcohol  diluted  with  its  own  weight  of  water ; 


GENERAL  TOXICOLOGY.  317 

but  the  addition  of  any  preservative  fluid  should  be 
avoided,  as  it  might  complicate  or  embarrass  future 
chemical  analysis. 

Urine  and  fcecal  matters  should  also  be  preserved. 

In  making  the  external  examination  the  procedure 
recommended  in  a  previous  chapter  should  be  adopted. 
If  any  spots  are  found  upon  the  skin,  lips,  or  fingers, 
they  should  be  removed  with  the  scalpel  for  future 
analysis ;  the  same  thing  should  be  done  with  the  teeth 
when  they  present  any  appearances  of  having  been 
stained  or  corroded. 

In  the  examination  of  the  interior  of  the  body  the 
chief  attention  should  be  directed  to  the  alimentary 
canal;  the  oesophagus  should  not  be  disturbed  in  the  ex- 
amination of  the  trachea.  The  condition  of  the  mouth 
and  pharynx  should  be  first  noted  before  the  organs 
in  the  chest  are  inspected.  The  left  lung  should  be 
reversed  upon  the  heart  to  expose  the  course  of  the 
oasophagus,  and  a  ligature  placed  around  it  close  to  the 
diaphragm ;  two  ligatures  should  then  be  placed  round 
the  duodenum  near  the  pyloric  end  of  the  stomach  and 
the  duodenum  divided  between  them  to  allow  the  re- 
moval of  the  stomach ;  the  same  thing  should  be  done 
at  the  termination  of  the  ilium  and  the  smaller  intestines 
removed.  Finally,  the  extremity  of  the  rectum  being 
secured,  the  larger  intestines  are  to  be  removed.  The 
stomach  and  intestines  should  then  be  opened  separately 
in  clean  glass  vessels  of  known  capacity ;  the  contents 
of  the  separate  portions  of  the  alimentary  canal,  the 
state  of  their  tissues  and  the  alterations  they  have  un- 
dergone should  be  carefully  noted.  The  quantity,  odor, 
acidity  or  alkalinity  of  the  contents  of  the  stomach, 


318  MEDICAL  JURISPRUDENCE. 

whether  luminous  or  not  in  the  dark,  the  presence  or 
absence  therein  of  crystalline  matter,  foreign  substances, 
undigested  food,  and  spirituous  fluid,  should  be  carefully 
noted.  The  appearance  of  the  rugae  of  the  stomach  and 
of  their  interspaces,  particularly  in  the  vicinity  of  the 
great  cul-de-sac,  should  be  noticed,  as  it  is  in  this  situa- 
tion that  the  traces  of  poison  and  its  effects  are  most 
frequently  left.  The  seat  of  inflammation,  if  any,  should 
be  exactly  specified,  as  also  that  of  any  softening  or  un- 
usual coloration,  ulceration,  effusion  of  blood,  corrosion, 
or  perforation,  if  there  should  be  any. 

The  same  minute  attention  should  be  paid  to  the 
smaller  and  larger  intestines  and  their  contents.  The 
parts  of  the  intestines  where  morbid  appearances  are 
most  frequently  found  in  case  of  poisoning,  are  the  duo- 
denum, the  upper  part  of  the  jejunum,  the  lower  part  of 
the  ilium  and  the  rectum.  The  comparative  intensity 
of  the  appearances  of  irritation  in  different  parts  of  the 
alimentary  canal  should  be  noticed,  as  it  may  throw 
much  light  on  a  suspected  case  of  poisoning,  and  may 
sometimes  obviate  the  necessity  for  any  further  pro- 
ceedings :  thus,  if  the  stomach  is  sound  and  the  intes- 
tines only  inflamed  the  possibility  of  irritant  poisoning 
may  be  pretty  safely  negatived. 

After  this  examination  of  the  stomach  and  intestines 
the  organs  are  to  be  put  into  wide-mouthed  glass  vessels, 
each  part  by  itself,  and  the  vessels  in  which  they  were 
contained  washed  out  with  distilled  water  into  the  ves- 
sel appropriated  to  the  morbid  part,  adding  sufficient 
distilled  water  to  cover  the  contained  viscus. 

When  the  poison  has  led  to  the  perforation  of  the 
stomach  and  bowels  the  substance  effused  into  the 


GENERAL  TOXICOLOGY.  319 

abdominal  cavity  should  be  carefully  collected  and 
separately  preserved. 

In  a  case  of  poisoning  by  arsenic  and  the  greater 
number  of  the  metallic  poisons,  the  liver  and  the  mass 
of  the  blood  may  require  to  be  preserved.  In  cases  of 
suspected  poisoning  with  opium  and  its  salts  and  all 
the  vegetable  alkaloids,  besides  the  portion  of  the  vis- 
cera most  largely  supplied  with  blood,  portions  of  the 
blood  and  the  whole  of  the  urine  should  be  kept. 

The  remaining  organs  of  the  abdomen  must  be  in- 
spected, particularly  the  spleen,  the  kidneys,  and  the 
rectum  ;  and  in  the  female,  the  uterus  and  its  append- 
ages including  the  vagina. 

No  portion  of  the  suspected  articles  should  be  wasted 
at  the  inspection  or  in  preliminary  trials  or  testing.  In 
some  instances  it  may  be  necessary  to  preserve,  besides 
a  portion  of  the  liver  and  the  blood,  other  parts  of  the 
body,  —  such  as  the  kidneys,  spleen,  heart,  brain,  and  por- 
tions of  the  muscles  ;  all  the  organs  and  the  blood  thus 
removed  should  be  collected  and  preserved  in  separate 
clean  glass  vessels,  great  care  being  taken  that  none  of 
the  organs  or  substances  thus  removed  at  any  time  be 
brought  in  contact  with  any  substance  which  might 
give  rise  to  a  suspicion  of  contamination.  A  sealed  and 
signed  label  ought  to  be  attached  to  each  of  the  vessels 
before  removal  from  the  apartment.  Great  care  should 
be  taken  to  prevent  the  possibility  of  their  being  tam- 
pered with,  and  they  should  be  retained  in  the  sole 
possession  of  the  inspector  until  delivered  by  him  to  a 
person  duly  authorized  to  receive  the  same. 

It  may  be  necessary  occasionally  to  examine  a  dead 
body  for  poison,  after  a  considerable  period  of  interment. 


320  MEDICAL  JURISPRUDENCE. 

Mere  putrefaction  should  not  be  allowed  to  prevent  an 
inspection  necessary  for  medico-legal  purposes.  It  has 
been  shown  by  the  experiments  of  Orfila  and  Lesueur 
that  the  decay  of  the  body  does  not  always  render  im- 
possible the  detection  of  the  poison.  They  placed  in  a 
dead  body,  and  allowed  to  remain  there  for  some  time, 
each  of  the  following  poisons,  namely :  sulphuric  and 
nitric  acid,  arsenic,  corrosive  sublimate,  tartar  emetic, 
sugar  of  lead,  protochloride  of  tin,  sulphate  of  copper, 
verdigris,  nitrate  of  silver,  chloride  of  gold,  acetate  of 
morphia,  chloride  of  brucia,  acetate  of  strychnia,  prussic 
acid,  opium,  and  cantharides.  They  found  that  the 
acids  become  neutralized  by  the  ammonia  generated 
during  the  decay  of  the  animal  matter ;  that  by  the 
action  of  the  animal  matter  the  salts  of  mercury,  anti- 
mony, copper,  tin,  gold,  silver,  and  likewise  the  salts  of 
the  vegetable  alkaloids,  undergo  chemical  decomposition 
in  consequence  of  which  the  bases  become  less  soluble  in 
water ;  that  acids  may  be  detected  after  several  years'  in- 
terment, not  always,  however,  in  the  free  state  ;  that  the 
bases  of  the  decomposed  metallic  salts  may  also  be  found 
after  interment  for  several  years ;  that  arsenic,  opium,  and 
cantharides  undergo  little  change  after  a  long  interval 
of  time,  and  are  scarcely  more  difficult  to  discover  in 
decayed  than  in  recent  animal  mixtures ;  but  that 
hydrocyanic  acid  disappears  very  soon,  so  as  to  be 
indistinguishable  after  a  few  days. 

4.  Evidence  of  Poisoning  derivable  from  Chemical 
Analysis.  —  We  have  already  indicated  our  opinion  that 
the  chemical  analysis  in  cases  of  suspected  poisoning 
should  be  made  by  a  competent  chemist,  and  cannot, 
as  a  rule,  be  safely  undertaken  by  a  general  medical 
practitioner. 


GENERAL  TOXICOLOGY.  321 

For  details  as  to  the  different  methods  of  analysis  the 
reader  is  referred  to  the  treatises  of  Wormley,  Taylor, 
and  Christison. 

In  this  connection  the  possibility  should  always  be 
borne  in  mind  that  the  poison  may  have  been  introduced 
into  the  body  after  death  with  the  design  to  impute 
poisoning ;  or  that  although  the  poison  was  swallowed 
during  life  the  fatal  event  may  have  arisen  from  natural 
causes;  it  should  always  be  remembered  that  a  large 
number  of  the  best  known  poisons  are  constantly  em- 
ployed as  medicinal  agents. 

5.  Experiments   on  animals   with  suspected  articles 
of  food,  drink,  or  medicine,  were  formerly  much  relied 
on  as  evidence  of  poisoning;  now,  however,  this  line 
of  proof  is  properly  objected  to  both  as  a  waste  of 
useful  material,  and  on  the  ground  that  the  effects  of 
poisons  on  the  lower  animals  are  frequently  different 
from  those  produced  on  man.     For  details  see  Ogston's 
"  Medical  Jurisprudence "  and  professed   treatises   on 
Therapeutics. 

6.  With  the  moral  aspects  of  the  case  the  medical  jur- 
ist as  such,  has  usually  nothing  to  do ;  but  in  his  capa- 
city as  a  practitioner  these  aspects  will  not  unfrequently 
be  brought  before  his  attention,  and  in  the  interests  of 
justice  should  be  carefully  observed  and  noted  by  him. 
In  many  instances  he  may  not  only  thereby  materially 
aid  the  interests  of  justice,  but  he  may  sometimes  there- 
by be  enabled  to  protect  his  patient  against  further 
attempts  at  poisoning. 

Treatment  of  Poisoning,  generally.  Before  proceeding 
farther  it  may  be  well  to  insert  at  this  place  a  few  gen- 
eral principles  as  to  the  methods  of  treatment  in  cases 

21 


322  MEDICAL  JURISPRUDENCE. 

of  poisoning.  The  details  must  of  course  be  sought  in 
larger  works  upon  Therapeutics  and  Toxicology. 

In  treating  a  case  of  suspected  poisoning  there  are 
three  indications  to  be  met:  1.  The  removal  of  the 
poison ;  2.  The  counteracting  of  the  primary  effects  of 
such  portions  of  the  poison  as  may  have  gotten  beyond 
reach ;  and  3.  The  cure  of  the  resulting  disorders  it  may 
have  occasioned. 

The  modes  of  removing  the  poison  vary  according  to 
circumstances. 

External  Applications,  etc.  — Some  poisons,  such  as  the 
strong  mineral  acids  and  the  caustic  alkalies,  act  on  the 
unbroken  surface  of  the  body,  while  the  far  greater 
number  require  to  be  introduced  below  the  surface. 
Where  the  poison  has  been  applied  outwardly,  careful 
ablution  will  in  many  instances  be  all  that  may  be  re- 
quired to  fulfil  the  first  indication. 

When,  however,  the  poison  has  penetrated  below  the 
external  surface,  the  following  steps  should  be  taken : 
A  ligature  should  be  applied  between  the  wound  or  sore 
and  the  heart  as  far  from  the  wound  as  possible,  so  as 
to  arrest  the  circulation  in  the  veins  but  not  in  the  ar- 
teries ;  this  will  if  adopted  in  time,  prevent  the  absorp- 
tion of  the  poison  or  arrest  its  further  absorption,  at  least 
for  a  time.  The  next  step  to  be  taken  is  to  wash  the 
wound  carefully  from  every  trace  of  the  poison,  and  to 
attempt  the  removal  of  so  much  of  the  poison  as  may 
adhere  to  the  wound  or  have  entered  the  circulation  at 
the  wounded  part.  Some  authors  advise  the  opening  of 
a  vein  near  the  ligature,  and  the  withdrawing  of  as  much 
of  the  local  blood  as  is  necessary  to  insure  the  safety  of 
the  patient.  Others  recommend  the  manipulation  of 


GENERAL  TOXICOLOGY.  323 

the  soft  parts  around  the  wound  so  as  by  compression 
to  squeeze  out  from  it  as  much  as  possible  of  the  blood 
it  contains.  A  better  procedure,  and  that  generally 
recommended,  is  suction,  either  by  the  mouth  or  cup- 
ping glass ;  dry  cupping  is  perhaps  the  best  method  and 
may  be  practised,  if  no  better  means  are  at  hand,  by 
burning  a  small  piece  of  paper  saturated  with  alcohol, 
in  a  small  wine-glass  or  tumbler,  and  having  removed 
the  remains  of  the  paper  immediately  placing  the  glass 
over  the  wounded  part.  Free  scarification  of  the  part 
will  add  to  the  efficiency  of  this  operation. 

Excision  of  the  soft  parts  in  the  vicinity  of  the  wound, 
or  even  the  amputation  of  the  part  when  the  wound  is 
situated  in  a  finger  or  a  limb,  may  sometimes  be 
necessary. 

Caustics  or  escharotics  or  actual  cautery  have  been 
recommended. 

When  poisons  have  been  applied  to  the  unbroken 
surface  or  the  entrance  of  the  various  mucous  canals,  so 
much  of  the  noxious  substance  as  possible  should  be 
speedily  washed  out;  and  in  the  case  of  the  mineral 
acids  and  alkalies,  the  remainder  neutralized  with  some 
appropriate  reagent. 

Where  a  volatile  poison  has  been  drawn  into  the 
lungs  by  inspiration  it  is  rapidly  absorbed  and  will 
usually  be  beyond  reach  before  any  attempt  at  its  re- 
moval can  be  made ;  in  such  case  the  only  resource 
within  our  power  is  the  continuance  of  full  and  rapid 
inspirations  and  expirations  to  dilute  and  carry  it  off. 
Artificial  respiration  with  or  without  the  addition  of 
vapor  of  ammonia  or  other  appropriate  drug,  may  be 
necessary. 


324  MEDICAL  JURISPRUDENCE. 

In  most  instances  in  which  the  intervention  of  a 
practitioner  is  necessary,  the  poison  will  have  been 
swallowed  and  the  first  most  important  aim  in  such 
case  will  be  to  procure  its  complete  and  speedy  removal 
from  the  stomach.  In  some  instances  the  poison  will 
itself  have  provoked  vomiting,  which  should  in  most 
instances  be  encouraged  by  the  use  of  the  mildest  dilu- 
ents. Where  vomiting  has  not  thus  spontaneously 
occurred,  or,  if  it  has  commenced,  is  not  sufficiently  free, 
emetics  should  be  at  once  administered  and  repeated  at 
suitable  intervals  till  their  full  action  is  obtained.  As 
a  general  rule,  the  milder  vegetable  emetics,  such  as 
ipecac  or  the  preparations  of  squill,  are  best  adapted  for 
the  irritant  and  many  of  the  narcotico-acrid  poisons; 
while  sulphate  of  zinc,  in  a  dose  of  five  grains  repeated 
every  ten  minutes  until  it  has  acted  freely,  will  be  found 
useful  in  the  case  of  a  narcotic  poisoning.  Common 
table-salt,  in  a  dose  of  one  or  two  tablespoonfuls  dis- 
solved in  eighteen  or  twenty  ounces  of  warm  water,  or, 
though  more  irritating,  one  or  two  teaspoonfuls  of 
mustard  in  warm  water,  will  be  found  useful  in  an 
emergency.  Simple  diluents  may  be  given  freely  to 
assist  the  action  of  the  above  emetics  and  vomiting 
may  be  hastened  or  assisted  by  tickling  the  throat  or 
compressing  the  epigastrium.  There  are  cases,  however, 
where  it  will  be  either  unsafe  to  administer  emetics  or 
where  if  administered,  they  will  fail  to  act ;  in  the  first 
category  are  patients  predisposed  to  or  who  have  al- 
ready suffered  from  apoplexy  or  haemoptysis. 

In  many  cases  the  hypodermatic  injection  of  from 
-fa  to  -3*3-  of  a  grain  of  apomorphia  will  be  found 
a  most  valuable  agent  in  procuring  the  complete  and 


GENERAL  TOXICOLOGY.  325 

speedy  evacuation  of  the  stomach.  A  strong  recom- 
mendation in  its  favor  is  the  fact  that  it  can  be  used  in 
cases  where  the  patient  cannot  swallow,  and  in  cases 
where,  as  in  strychnia  poisoning,  the  administration 
of  an  emetic  or  the  use  of  a  stomach-pump  is  difficult 
or  impossible,  by  reason  of  convulsions.  In  many  cases 
the  stomach-pump  may  be  safely  used ;  its  use,  however, 
is  sometimes  difficult  or  impossible  in  the  case  of  chil- 
dren, and  as  before  mentioned,  during  the  continuance 
of  convulsions  ;  while  it  may  be  altogether  contra-indi- 
cated in  some  cases  of  corrosive  poisoning.  Where  the 
patient's  mouth  cannot  be  opened,  on  account  of  spasms, 
it  should  be  remembered  that  a  small  tube  may  be  in- 
troduced into  the  stomach  through  the  nostril.  It  may 
occasionally  be  necessary,  as  a  means  of  fulfilling  the 
first  indication,  to  expel  per  anum,  by  the  use  of  laxa- 
tive medicines,  portions  of  the  poison  which  have  passed 
from  the  stomach  into  the  intestines.  Castor  oil  is  the 
cathartic  usually  chosen,  on  account  of  its  mildness; 
when  necessary  its  efficacy  may  be  increased  by  addition 
to  it  of  one  or  two  drops  of  croton  oil. 

The  second  indication  is  the  counteracting  of  the 
primary  effects  of  such  portions  of  the  poison  as  have 
gotten  beyond  our  reach  ;  and  the  third  indication  is  the 
cure  of  the  resulting  disorders  the  poison  may  have 
occasioned. 

Inasmuch  as  it  is  seldom  that  the  whole  of  the  poison 
can  at  once  be  removed  from  the  system  by  any  means 
at  our  command,  we  may  usually  find  it  necessary  to 
attempt  to  meet  these  second  and  third  indications. 
To  consider  this  subject  at  length  or  even  partially 
would  occupy  more  space  than  is  at  our  disposal ;  we 


326  MEDICAL  JURISPRUDENCE. 

are  obliged,  therefore,  to  refer  the  student  for  particulars 
in  this  important  subject  to  the  excellent  works  of  Drs. 
Wood  and  Bartholow  on  Therapeutics. 

Feigned  Poisoning,  Imputed  Poisoning,  etc.  —  The 
imputation  of  the  crime  of  poisoning  by  feigning  or 
actually  producing  the  symptoms  and  contriving  that 
the  poison  shall  be  detected  in  the  quarters  where  in 
actual  cases  it  is  usually  sought  for,  has  sometimes  been 
attempted.  It  is  very  easy  for  an  artful  person  to  put 
poison  into  food  and  accuse  another  of  having  admin- 
istered it,  as  well  as  to  introduce  poison  into  fseces  or 
matters  vomited.  The  possibility  also  of  the  introduc- 
tion of  a  poisonous  substance  into  the  body  after  death, 
with  a  view  of  accusing  an  innocent  person  of  the  crime 
of  poisoning,  should  also  be  borne  in  mind. 

In  cases  of  feigned  poisoning,  the  absence  of  the 
characteristic  symptoms  of  the  poison  alleged  to  have 
been  taken,  with  other  inconsistencies  in  the  account  of 
the  party,  will  usually  disclose  the  fraud.  In  such 
cases,  in  forming  a  diagnosis  little  reliance  should  be 
placed  on  the  unsupported  statement  of  the  patient; 
the  practitioner,  while  allowing  the  patient  apparent 
credit  for  the  truth  of  his  statements  and  seemingly 
sympathizing  with  his  fears, — real,  imaginary  or  as- 
sumed, —  should  request  him  to  give  a  full  history  of 
existing  symptoms,  their  origin  and  progress,  their  rela- 
tion in  point  of  time  to  various  meals,  and  the  mode 
and  vehicle  in  which  the  supposed  poison  was  admin- 
istered. The  same  course  should  be  taken  with  attend- 
ants, witnesses  or. others  interested  in  supporting  the 
statement,  either  during  his  lifetime  or  after  death  in 
cases  of  suspected  fatal  poisoning.  No  unprofessional 


GENERAL  TOXICOLOGY.  327 

person  can  go  through  such  an  ordeal  without  bringing 
out  many  circumstances  irreconcilable  with  the  idea  of 
poisoning  generally,  and  still  more  the  administration 
of  a  particular  poison,  unless  it  has  in  fact  been 
administered. 

In  many  cases  it  will  be  found  that  the  party  is  not 
entirely  free  from  some  complaint.  In  imaginary  poi- 
soning there  will  often  be  disorder  of  the  digestive 
organs,  irritation  of  the  alimentary  canal,  febrile  or 
inflammatory  symptoms,  with  or  without  delusion  or 
hallucination  showing  that  the  mind  is  disordered.  In 
suspected  poisoning  the  same  circumstances  will  have 
served  as  grounds  for  suspicion. 

In  feigned  and  imputed  poisoning,  if  there  be  no  ill- 
ness to  give  a  color  to  the  imposture  there  will  be  a 
fictitious  disorder  produced.  In  all  these  cases,  there- 
fore, it  should  first  be  settled  whether  or  not  there  be 
any  actual  departure  from  the  state  of  health.  This 
done,  the  additional  evidence  which  the  ejecta  and 
dejecta  (if  any  such  are  produced)  are  capable  of  afford- 
ing, care  being  taken  to  ascertain  that  poison  has  not 
purposely  been  added  to  these,  will  usually  be  sufficient 
to  determine  the  question.  It  may  be  necessary  in 
order  to  settle  the  question  definitely,  to  have  the  per- 
son and  those  about  him  secretly  watched. 

In  a  case  of  importance  where  active  disease  is  found 
to  exist,  the  medical  jurist  will  not  be  justified  in  de- 
ciding positively  that  a  poison  has  not  been  exhibited 
without  a  previous  careful  examination  of  the  suspected 
articles,  food  or  drink,  and  of  the  ejecta.  The  chemical 
investigation  may  sometimes  lead  to  proof  of  the  reality 
of  an  apparent  case  of  feigned,  suspected,  or  imaginary 
poisoning. 


CHAPTER  XXL 

INSANITY.1 

THE  compiler  of  this  little  volume  has  felt  great 
embarrassment  iu  the  preparation  of  this  chapter  and 
the  chapter  upon  Toxicology,  on  account  of  the  wealth 
of  material  and  the  difficulty  of  determining  what  to 
omit ;  for  with  the  limited  space  at  his  disposal  nothing 
more  than  a  mere  outline  can  be  attempted. 

It  is,  perhaps,  impossible  to  frame  a  perfect  definition 
of  insanity ;  if  space  permitted  it  would  be  a  matter  of 
great  interest  to  collate  and  compare  the  different  defini- 
tions, and  to  study  their  development.  Quite  a  full 
compilation  of  the  various  definitions  of  insanity  will  be 
found  in  Dr.  Hammond's  work  on  that  subject,  who  de- 
fines it  as  "a  manifestation  of  disease  of  the  brain, 
characterized  by  general  or  partial  derangement  of  one 
or  more  faculties  of  the  mind,  and  in  which,  while  con- 
sciousness is  not  abolished,  mental  freedom  is  weakened, 
perverted,  or  destroyed  :  "  insanity  is  regarded  by  this 
writer  as,  strictly  speaking,  "  only  a  symptom  of  cerebral 
disease." 

Dr.  Spitzka  gives  the  following  comprehensive  defini- 
tion of  insanity,  which,  he  states,  complies  with  the 
chief  requirements  of  a  practical  definition,  although 

*  The  material  for  this  chapter  has  with  the  author's  consent  been 
largely  drawn  from  the  manual  of  Dr.  Spitzka  upon  Insanity,  which 
every  student  should  consult  for  further  details. 


INSANITY.  329 

laboring  under  the  disadvantage  of  length :  "  Insanity  is 
either  the  inability  of  the  individual  to  correctly  regis- 
ter and  reproduce  impressions  (and  conceptions  based 
on  these)  in  sufficient  number  and  intensity  to  serve  as 
guides  to  actions  in  harmony  with  the  individual's  age, 
circumstances,  and  surroundings,  and  limit  himself  to 
the  registration  as  subjective  realities  of  impressions 
transmitted  by  the  peripheral  organs  of  sensation ;  or 
the  failure  to  properly  co-ordinate  such  impressions  and 
thereon  to  frame  logical  conclusions  and  actions  ;  these 
inabilities  and  failures  being  in  every  instance  considered 
as  excluding  the  ordinary  influence  of  sleep,  trance, 
somnambulism,  the  common  manifestation  of  the  general 
neuroses,  such  as  epilepsy,  hysteria,  and  chorea,  of 
febrile  delirium,  coma,  acute  intoxication,  intense  men- 
tal pre-occupation,  and  the  ordinary  immediate  effects 
of  nervous  shocks  and  injuries."  In  another  place  the 
same  author  gives  the  following  definition :  "  Insanity 
is  a  term  applied  to  certain  results  of  brain  disease  and 
brain  defect  which  invalidate  mental  integrity.  It  is  in- 
accurate to  state  that  insanity  is  itself  a  disease.  It  is, 
strictly  speaking,  merely  a  symptom  which  may  be  due  to 
many  different  morbid  conditions,  showing  this  one  fea- 
ture in  common,  —  that  they  involve  the  organ  of  the 
mind." 

Dr.  Kiernan,  of  Chicago,  has  favored  the  author  with 
the  following  definition :  "  Insanity  is  a  morbid  mental 
condition  arising  from  brain  disease,  or  disorder,  or  mal- 
formation, which  perverts  the  mental  relations  of  the  in- 
dividual to  his  surroundings,  or  to  what  from  his  birth, 
education,  and  circumstances,  might  be  expected  to  be 
such  surroundings." 


330  MEDICAL  JURISPRUDENCE. 

Dr.  Henry  M.  Bannister  of  the  Illinois  Hospital  for 
the  Insane,  at  Kankakee,  has  also  favored  us  with 
the  following  definition:  "Insanity  is  a  disease  or 
defect  of  the  brain,  causing  such  disorder  in  the  action 
of  the  mind  as  to  affect  the  individual's  conduct,  put 
him  out  of  relation  to  his  surroundings,  and  render  him 
liable  to  be  dangerous  or  inconvenient  to  himself  or 
others.  Under  insanity  are  not  usually  included  the 
delirium  of  fever,  or  the  direct  effects  of  toxic  agents, 
intoxicants,  etc." 

Dr.  Bucknill,  in  his  essay  on  "  Unsoundness  of  Mind  in 
relation  to  Criminal  Acts,"  defines  insanity  as  "  a  con- 
dition of  mind  in  which  a  false  action  of  conception  or 
judgment,  a  defective  power  of  the  will,  or  an  uncontrol- 
lable violence  of  the  emotions  and  instincts,  have  separ- 
ately or  conjointly  been  produced  by  disease." 

The  same  author  has  lately  propounded  a  new  defini- 
tion which  is  intended  to  express  the  essential  features  of 
insanity  from  a  legal  point  of  view.  He  says :  "  Insanity 
is  incapacitating  weakness  or  derangement  of  mind 
caused  by  disease." 

It  does  not  appear  to  us  that  this  definition  adds 
greatly  to  our  stock  of  knowledge  upon  this  important 
subject ;  it  only  removes  the  difficulty  one  step  further, 
without  in  the  least  aiding  in  the  solution  of  the  ques- 
tion as  to  what  does  amount  to  legal  irresponsibility. 
But  this  subject  will  be  referred  to  further  on. 

Dr.  Tuke,  in'"  Bucknill  and  Tuke's  Manual  of  Psycho- 
logical Medicine,"  regards  insanity  as  "a  condition  in 
which  the  intellectual  faculties,  or  the  moral  sentiments, 
or  the  animal  propensities,  —  any  one  or  all  of  them,  — 
have  their  free  action  destroyed  by  disease,  whether  con- 


INSANITY.  331 

genital  or  acquired."  "  He  [the  student]  will  not  go  far 
wrong,"  says  Dr.  Tuke, "  if  he  regard  insanity  as  a  disease 
of  the  brain  (idiopathic  or  sympathetic)  affecting  the 
integrity  of  tlie  mind,  whether  marked  by  intellectual  or 
emotional  disorder,  —  such  effects  not  being  the  mere 
symptom  or  immediate  result  of  fever  or  poison." 

It  will  be  seen  from  the  above  definitions  and  others 
quoted  in  Dr.  Hammond's  work  that  there  is  a  great 
difference  of  opinion  as  to  what  is  a  proper  definition  of 
insanity.  We  have  quoted  the  above  definitions  for  the 
reason  that,  excepting  the  proposed  new  definition  of  Dr. 
Bucknill,  they  seem  to  us  to  define  the  condition  of  in- 
sanity more  clearly  than  those  proposed  by  other  authors. 
Some  of  these  authors,  it  will  be  observed,  regard  insan- 
ity as  a  disease  or  defect  of  the  brain,  causing  certain 
mental  phenomena ;  others  apply  the  term  to  the  phe- 
nomena themselves,  or  the  mental  condition  which  they 
represent,  caused  by  a  disease  or  defect  of  the  brain ;  or 
as  Dr.  Hammond  expresses  it,  "  insanity,  strictly  speak- 
ing, is  only  a  symptom  of  cerebral  disease."  Dr.  Spitzka 
likewise,  as  we  have  seen,  characterizes  insanity  as 
merely  a  symptom. 

In  the  present  state  of  our  knowledge,  it  seems  to  the 
writer  better  to  apply  the  term  "  insanity  "  to  the  condi- 
tion of  mind  evidenced  by  the  mental  phenomena  ob- 
served, rather  than  to  the  disease  of  the  brain  causing 
such  condition.  This,  however,  is  perhaps  not  a  vital 
point,  and  any  one  of  the  three  definitions  above  quoted 
of  Dr.  Bannister,  Dr.  Spitzka,  or  Dr.  Hammond,  will 
perhaps  include  the  vast  majority  of  cases. 

It  is  probably  more  convenient  than  necessary  that 
any  attempt  should  be  made  to  frame  a  definition  of 


332  MEDICAL  JURISPRUDENCE. 

insanity  which  will  include  all,  or  the  greater  number 
of  cases.  A  very  superficial  view  of  the  growth  of  our 
knowledge  upon  this  subject  shows  clearly  the  folly  of 
attempting  to  frame  a  rigid  definition.  A  definition 
which  at  the  time  it  is  made  may  appear  to  be  perfect 
will,  with  the  enlargement  of  our  knowledge  and  ex- 
perience, be  found  defective.  As  is  well  observed  by 
Dr.  Spitzka,  the  chief  need  of  a  definition  is  a  medico- 
legal  one,  and  we  think  that  it  may  be  stated  that  this 
need  is  not  a  pressing  one ;  it  is  much  better  in  our 
judgment,  as  in  the  case  of  fraud,  to  decide  each  case 
upon  its  individual  facts,  than  to  attempt  to  make 
it  square  with  any  rigid  and,  very  likely,  imperfect 
definition. 

With  reference  to  this  subject,  Dr.  Spitzka  observes : 
"On  some  occasions  the  question  of  defining  what  is 
called  '  legal  insanity '  may  be  presented  to  the  reader 
of  these  lines.  When  that  question  is  asked  he  may 
safely  challenge  the  questioner  to  show  him  a  broken 
leg,  or  a  case  of  small-pox  in  a  hospital  ward,  which  is 
not  a  broken  leg  or  a  case  of  small-pox  in  law ;  or  show 
him  a  tumor,  or  case  of  softening  of  the  brain,  which  is 
meningitis  or  sclerosis  in  law ;  or  to  define  the  condition 
under  which  any  disease-symptom  becomes  an  indication 
of  health.  When  these  conditions  are  complied  with,  and 
not  till  then,  may  physicians  attempt  to  define  '  insanity 
in  law '  as  distinguishable  from  insanity  in  science  ;  in 
the  meantime  he  may  rest  contented  with  the  dictum  of 
one  of  the  best  legal  authorities,  '  that  that  cannot  be 
sanity  in  law  which  is  insanity  in  science,  just  as  nothing 
can  be  a  fact  in  science  and  a  fiction  in  law  at  one  and 
the  same  time.' " 


INSANITY.  333 

The  characteristic  evidences  of  insanity  are,  by  Dr. 
Spitzka  in  his  manual,  for  practical  purposes,  divided 
into  two  groups:  the  somatic  or  physical  indications, 
and  the  mental  symptoms  proper.  The  physical  symp- 
toms furnish  evidence  of  the  physical  nature  of  the 
disorder,  and  are  indications  for  medical  treatment.  It 
is,  however,  beyond  the  scope  of  this  work  to  consider 
them  in  this  place ;  for  details  upon  this  subject,  see 
the  treatises  of  Drs.  Spitzka  and  Hammond.  We  may, 
however,  in  this  connection  mention,  as  frequent  ac- 
companiments of  insanity,  certain  disturbances  of  sen- 
sibility; the  facts  that  the  functions  of  the  intestinal 
canal  in  some  forms  of  insanity  show  great  disturbance, 
that  the  condition  of  the  skin  and  its  secretions  are 
sometimes  greatly  altered ;  anomalies  of  appetite ;  mo- 
tor and  trophic  disturbances,  etc. 

The  mental  symptoms  proper,  while  furnishing  hints 
for  moral  treatment,  are  principally  valuable  for  general 
diagnostic  and  medico-legal  purposes,  and  to  these  our 
attention  will  at  present  be  confined. 

The  principal  mental  symptoms  are  the  existence 
of  hallucinations,  illusions,  delusions,  incoherence,  de- 
lirium, imperative  conceptions,  morbid  propensities,  a 
variety  of  emotional  disturbances,  and  various  disturb- 
ances of  the  memory,  the  consciousness,  and  the  will. 
We  do  not  mean  to  be  understood  as  saying  that  all  or 
any  considerable  number  of  these  symptoms  are  to  be 
expected  in  any  one  case,  nor  that  any  one  may  be  con- 
sidered as  a  criterion  of  the  existence  of  insanity. 

It  may  perhaps  be  well  to  define  some  of  these 
symptoms,  although  little  more  can  be  attempted  in 
this  connection  than  a  definition. 


334  MEDICAL  JURISPRUDENCE. 

An  illusion  is  defined  by  Dr.  Hammond  as  being  a 
false  perception  of  a  real  sensorial  impression.  Illusions 
of  all  senses,  but  especially  of  sight  and  hearing,  are 
found  in  insanity,  and  particularly  in  acute  forms  with 
delirium.  Persistent  presence  of  illusions,  while  not 
conclusive  evidence  of  insanity,  is  evidence  of  brain 
disease,  which,  if  it  has  not  already  caused  insanity, 
may  do  so  at  any  time. 

An  hallucination  is  defined  by  the  same  author 
as  a  false  perception  without  any  material  basis,  and 
therefore  centric  in  its  origin.  These  are  always  evi- 
dences of  cerebral  disease,  and  common  phenomena  of 
insanity. 

A  delusion  exists  where  an  illusion  or  hallucination 
is  accepted  and  acted  upon  as  real,  and  of  the  falsity 
of  which  the  patient  cannot  be  convinced.  It  is  de- 
fined by  Dr.  Spitzka  as  a  faulty  belief  out  of  which 
for  the  time  being  the  subject  cannot  be  reasoned  by 
adequate  methods. 

The  existence  of  delusions  was  formerly  regarded  as 
the  true  criterion  of  insanity.  This  rule  was  laid  down 
by  Sir  John  Nichol  in  the  celebrated  case  of  Dew  vs. 
Clarke ;  but  it  cannot  now  be  regarded  as  sound,  inas- 
much as  there  are  undoubtedly  cases  of  insanity  in 
which  there  is  no  delusion.  Where  a  delusion  exists, 
however,  it  is  clear  evidence  of  insanity,  provided  it 
relates  to  a  matter  of  fact,  as  distinguished  from  faith, 
and  is  contrary  to  the  customary  mode  of  thought  of 
the  individual,  and  held  in  opposition  to  such  evidence 
as  is  logically  opposed  thereto.  Where,  however,  a  de- 
lusion, though  based  partly  on  faith,  urges  the  subject 
to  do  some  criminal  act  of  violence,  as,  for  instance,  to 


INSANITY.  335 

sacrifice  his  son,  —  this  would  be  considered  an  insane 
delusion. 

Spitzka  divides  delusions  into  two  classes,  genuine 
and  spurious ;  the  former  of  which  have  been  princi- 
pally created  by  the  patient  himself,  and  the  latter 
adopted  from  others.  Genuine  delusions  are  again 
divided  by  this  author  into  systematized  and  unsys- 
tematized. 

Incoherence  needs  no  definition ;  it  appears  to  be 
due  to  an  inability  to  concentrate  the  attention,  or  to 
a  lack  of  power  in  co-ordinating  the  different  parts  of 
the  brain  concerned  in  the  formation  and  expression 
of  ideas.  It  will  generally  be  found  some  time  or  other 
in  cases  of  acute  mania,  and  is  common  in  imbecility 
and  in  chronic  insanity  of  any  kind. 

Delirium  is  defined  by  Dr.  Hammond  as  being  that 
condition  in  which  there  are  illusions,  hallucinations, 
delusion,  and  incoherence,  together  with  a  general  ex- 
cess of  motility,  and  inability  to  sleep,  and  acceleration 
of  pulse.  It  is  commonly  found  in  the  first  stage  of 
acute  mania,  although  it  may  exist  at  the  beginning 
of  any  kind  of  insanity. 

Morbid  propensities  and  imperative  conceptions,  lead- 
ing to  what  is  called  morbid  impulse,  are  character- 
istics of  those  groups  of  insanity  called  pyromania, 
where  there  is  a  morbid  impulse  to  commit  arson,  klep- 
tomania, to  steal,  etc.  The  acts  arising  from  these 
morbid  impulses  have  been  made  by  some  writers  the 
foundation  of  many  different  classes  of  insanity ;  these 
terms  are  perhaps  convenient  as  a  means  of  designating 
the  leading  symptoms  of  particular  cases  of  insanity, 
but  as  a  basis  of  classification  are  of  little  value. 


336  MEDICAL  JURISPRUDENCE. 

Emotional  disturbances  exist  almost  universally  in 
the  insane.  Spitzka  lays  it  down  as  a  cardinal  canon 
of  psychiatry  that  in  insanity  the  moral  feelings  are 
usually  more  or  less  dulled  or  perverted. 

The  memory  often  suffers  temporary  disturbance  in 
cases  of  acute  and  transitory  forms,  and  in  exacerba- 
tions of  chronic  forms.  In  terminal  deterioration  there 
is  a  progressive  and  permanent  loss  of  memory. 

Disturbances  of  consciousness  may  rarely  result  in  a 
change  in  the  sense  of  identity,  and  in  the  rare  con- 
dition of  double  or  alternating  consciousness. 

The  will  some  time  or  other  in  the  progress  of  the 
disease  more  or  less  disturbed  in  all  cases  of  insanity. 

Classification.  —  There  are  almost  as  many  different 
systems  of  classification  of  the  various  forms  of  in- 
sanity as  there  are  writers  upon  this  subject.  Classi- 
fications have  been  made  in  a  variety  of  methods, 
depending  on  the  standpoint  from  which  the  subject 
has  been  viewed.  Insanity  has  thus  been  classified 
from  the  anatomical,  physiological,  etiological,  psycho- 
logical, pathological,  and  clinical  or  symptomatological 
standpoint.  Considering  the  imperfect  state  of  our 
knowledge  upon  the  subject,  the  classification  based 
upon  the  clinical  or  symptomatological  characteristics 
of  insanity  would  seem  to  be  the  most  practical,  and 
it  is  at  the  present  time,  perhaps,  the  system  of  classi- 
fication adopted  by  the  best  authors.  "With  advancing 
knowledge  it  is  very  likely  that  a  new  and  more  satis- 
factory classification  may  be  made  in  some  one  of  the 
other  different  methods  above  specified,  but  at  present 
it  does  not  seem  possible. 

We  can  in  this  connection  do  little  more  than  repro- 


INSANITY.  337 

duce  the  leading  classifications  of  Krafft-Ebing,  and  of 
the  three  leading  American  writers  upon  this  subject,  — 
Dr.  Spitzka,  Dr.  Hammond,  and  Dr.  Kay. 

The  classification  of  Krafft-Ebing  is  as  follows  :  — 

A.  Mental  affections  of  the  developed  brain. 

I.  Psychoneuroses. 

1.  Primary  curable  conditions. 

a.  Melancholia. 

a.  Melancholia  passiva. 
/8.  Melancholia  attonita. 

b.  Mania. 

a.  Maniacal  exaltation. 
j8.  Maniacal  frenzy. 

c.  Stupor. 

2.  Secondary  incurable  states. 

a.  Secondary  monomania  (secundaere  verruecktheit). 

b.  Terminal  dementia. 

a.  Dementia  agitata. 
£.  Dementia  apathetica. 
II.  Psychical  degenerative  states. 

a.  Constitutional  affective  insanity  (folie  raissonante). 

b.  Moral  insanity. 

c.  Primary  monomania  (primaere  verruecktheit). 

a.  With  delusions. 

oa.  Of  a  persecutory  tinge. 

/3£.  Of  an  ambitious  tinge. 
/3.  With  imperative  conceptions. 

d.  Insanities  transformed  from  the  constitutional  neuroses. 

o.  Epileptic. 

0.  Hysterical. 

y.  Hypochondriacal. 

e.  Periodical  insanity. 

III.  Brain  diseases,  with  predominating  mental  symptoms. 

a.  Dementia  paralytica. 

b.  Lues  cerebralis. 

c.  Chronic  alcoholism. 

d.  Senile  dementia. 

e.  Acute  delirium. 

B.  Mental  results  of  arrested  brain  development :  idiocy  and  cretinism. 

22 


338  MEDICAL  JURISPRUDENCE. 

Dr.  Spitzka's  classification  is  as  follows :  — 

GROUP  FIRST.  — PURE  INSANITIES. 

SUB-GROUP  A. 

Simple  Insanity,  not  essentially  the  manifestation  of  a  constitutional 
neurotic  condition. 

First  Class. 
Not  associated  with  demonstrable  active  organic  changes  of  the  brain. 

I.  DIVISION.    Attacking  the  individual  irrespective  of  the  physiologi- 

cal periods. 

a.  Order.     Of  primary  origin. 
Sub-Order  A.     Characterized  by  a  fundamental  emotional  disturbance. 

Genus  1 :  of  a  pleasurable  and  expansive  character,  — simple  mania. 

Genus  2 :  of  a  painful  character,  —  simple  melancholia. 

Genus  3 :  of  a  pathetic  character,  —  katatonia. 

Genus  4 :  of  an  explosive,  transitory  kind,  —  transitory  frenzy. 
Sub-Order  B.     Not  characterized  by  a  fundamental  emotional  dis- 
turbance. 

Genus  5 :  with  simple  impairment  or  abolition  of  mental  energy, 
—  stuporous  insanity. 

Genus  6 :  with  coufusional  delirium, — primary  confusioiral  insanity. 

Genus  7 :  with  uncomplicated  progressive  mental  impairment,  — 

primary  deterioration. 
/3  Order.     Of  secondary  origin. 

Genus  8  :  secondary  confusional  insanity. 

Genus  9 :  terminal  dementia. 

II.  DIVISION.    Attacking  the  individual  in  essential  connection  with 

the  developmental  or  involutional  periods.     (A  single  order. ) 
Genus  10 :  with  senile  involution,  —  senile  dementia. 
Genus  11 :  with  the  period  of  puberty,  —  insanity  of  pubescence 

(hebephrenia). 

Second  Class. 
Associated  with  demonstrable  active  organic  changes  of  the  brain. 

(Orders  coincide  with  genera.) 

Genus  12  :  which  are  diffuse  in  distribution,  primarily  vaso-motor 
in  origin,  chronic  in  course,  and  destructive  in  their  results,  — 
paretic  dementia. 


INSANITY.  339 

Genus  13:  having  the  specific  luetic  character, — syphilitic  de- 
mentia. 

Genus  14  :  of  the  kind  ordinarily  encountered  by  the  neurologist, 
such  as  encephalo-malacia,  haemorrhage,  neoplasms,  meningitis, 
parasites,  etc.,  —  dementia  from  coarse  brain  disease. 

Genus  15 :  which  are  primarily  congestive  in  character  and  furi- 
bund  in  development,  —  delirium  grave  (acute  delirium,  manic 
grave). 

SUB-GROUP  B. 

Constitutional  Insanity,  essentially  the  expression  of  a  continuous 
neurotic  condition. 

Third  Class. 
Dependent  on  the  great  neuroses.     (Orders  and  genera  coincide.) 

I.  DIVISION.     The  toxic  neuroses. 

Genus  16  :  due  to  alcoholic  abuse,  —  alcoholic  insanity. 
(Analogous  forms,  such  as  those  due  to  abuse  of 
opium,  the  bromides,  and  chloral,  need  not  be 
enumerated  here,  owing  to  their  rarity.) 

II.  DIVISION.     The  natural  neuroses. 

Genus  17  :  the  hysterical  neurosis,  —  hysterical  insanity. 
Genus  18 :  the  epileptic  neurosis,  —  epileptic  insanity. 

Fourth  Class. 
Independent  of  the  great  neuroses  (representing  a  single  order). 

Genus  19  :  in  periodical  exacerbations,  —  periodical  insanity. 

,-.  ,  ,  (  Genus  20  :  idiocy  and  imbecility. 

Order :   arrested  development  3 

(  Genus  21  :  cretinism. 

Genus  22  :  manifesting  itself  in  primary  dissociaticn  of  the  mental 
elements  or  in  a  failure  of  the  logical  inhibitory  power,  or  of 
both,  —  paranoia  (monomania). 

GROUP  SECOND.  — COMPLICATING  INSANITIES. 

These  may  be  divided  into  the  following  main  orders,  which,  as  a 
general  thing,  are  at  the  same  time  genera  :  Traumatic,  Choreic,  Post- 
febrile,  Rheumatic,  Gouty,  Phthisical,  Sympathetic,  Pellagrous. 


340  MEDICAL  JURISPRUDENCE. 

Dr.  Hammond's  classification  is  as  follows  :  — 

I.  Perceptional  Insanities.     Insanities  in  which  there  are  derange- 
ments of  one  or  more  of  the  perceptions, 
a.  Illusions. 
1).  Hallucinations. 

II.  Intellectual  Insanities.  Forms  in  which  the  chief  manifestations 
of  mental  disorder  relate  to  the  intellect,  being  of  the 
nature  of  false  conceptions  (delusions)  or  clearly  abnor- 
mal conceptions. 

a.  Intellectual  monomania  with  exaltation. 

b.  Intellectual  monomania  with  depression. 

c.  Chronic  intellectual  mania. 

d.  Reasoning  mania. 

e.  Intellectual  subjective  morbid  impulses. 

f.  Intellectual  objective  morbid  impulses. 

III.  Emotional  Insanities.    Forms  in  which  the  mental  derangement 

is  chiefly  exhibited  with  regard  to  the  emotions. 

a.  Emotional  monomania. 

b.  Emotional  morbid  impulses. 

c.  Simple  melancholia. 

d.  Melancholia  with  delirium. 

e.  Melancholia  with  stupor. 

f.  Hypochondriacal  mania,  or  melancholia. 

g.  Hysterical  mania, 
h.  Epidemic  insanity. 

IV.  Volitional  Insanities,     Forms  characterized  by  derangement  of  the 

will,  either  by  its  abnormal  predominance  or  inertia. 

a.  Volitional  morbid  impulses. 

b.  Aboulomania  (paralysis  of  the  will). 

V.  Compound  Insanities.  Forms  in  which  two  or  more  categories 
of  mental  faculties  are  markedly  involved. 

a.  Acute  mania.  4 

b.  Periodical  insanity. 

c.  Hebephrenia. 

d.  Circular  insanity. 

e.  Katatonia. 

f.  Primary  dementia. 


INSANITY. 


341 


g.  Secondary  dementia. 

h.  Senile  dementia. 

i.  General  paralysis. 

VI.  Constitutional  Insanities.  Forms  which  are  the  result  of  a  pre- 
existing physiological  or  pathological  condition,  or  of 
some  specific  morbid  influence  affecting  the  system. 

a.  Epileptic  insanity. 

b.  Puerperal  insanity. 

c.  Pellagrous  insanity. 

d.  Choreic  insanity,  etc. 
VII.  Arrest  of  Mental  Development. 

a.  Idiocy. 

b.  Cretinism. 

Inasmuch  as  Dr.  Eay's  classification  has  long  been 
before  the  profession,  and  has  been  adopted  in  whole  or 
in  part  by  many  other  writers,  we  reproduce  it  in  this 
connection  as  follows  :  — 


Insanity. 


Defective  devel 
opmentof  the  . 
faculties. 


Lesion  of  the 
faculties  sub- 
sequent to 
their  develop- 
ment. 


Idiocy. 


Imbecility.  • 


Mania.  • 


Dementia.  . 


1.  Resulting    from    con- 

genital defect. 

2.  Resulting  from  an  ob- 
stacle to  the   develop- 
ment   of    the   faculties 
supervening  in  infancy. 

1.  Resulting    from    con- 
genital defect. 

2.  Resulting  from  an  ob- 
stacle to  the   develop- 
ment  of   the    faculties 
supervening  in  infancy. 

General. 
Partial. 

r  1.  General. 
Affective.  )  „    „    , .  , 
(  2.  Partial. 

1.  Consecutive  to  mania, 
or     injuries     of     the 
brain. 

2.  Senile,  peculiar  to  old 


Intellectual. 


342  MEDICAL  JURISPRUDENCE. 

With  respect  to  the  subject  of  classification  Dr.  Eay 
observes  that  "it  is  not  pretended  that  any  classifica- 
tion can  be  rigorously  correct,  for  such  divisions  have 
not  been  made  by  nature  and  cannot  be  observed 
in  practice.  Diseases  are  naturally  associated  into  some 
general  groups  only,  and  if  these  be  ascertained  and 
brought  into  view,  the  great  end  of  classification  is  ac- 
complished. We  shall  often  find  them  run  into  each 
other,  and  be  puzzled  to  assign  to  a  particular  disease 
its  proper  place." 

With  reference  to  Dr.  Eay's  classification,  which  with 
some  modifications  is  that  adopted  by  Esquirol,  it  is  to 
be  observed  that  it  is  at  present,  as  it  seems  to  the 
writer,  too  narrow  in  its  limits,  and  does  not  include 
many  well-recognized  forms  of  insanity. 

Dr.  Hammond's  classification  is  not  claimed  by  him 
to  be  perfect.  Its  several  groups  are  not,  so  he  says, 
in  all  cases  clearly  separated  from  each  other.  Particular 
forms  of  insanity,  in  his  classification,  are  placed  in  the 
divisions  indicated  respectively  by  their  chief  manifes- 
tations of  mental  disorder. 

The  classification  of  Krafft-Ebing  is  objectionable  on 
account  of  his  making  to  some  extent  curability  and  in- 
curability the  basis  of  the  same,  as  well  as  on  other  ac- 
counts which  will  be  found  well  stated  by  Dr.  Spitzka 
in  Chapter  XL  of  his  manual. 

So  far  as  we  have  been  able  to  understand  the  subject, 
the  classification  of  Dr.  Spitzka,  while  somewhat  more 
complex  than  other  systems,  appears  to  be  the  most 
scientific,  and  more  exhaustive  than  any  other  classifica- 
tion which  has  been  proposed.  But  as  we  have  already 
stated,  any  classification  made  in  the  present  state  of  our 


INSANITY.  343 

knowledge  will  probably  be  of  comparatively  temporary 
value,  and  must  be  modified  with  the  advance  of  our 
knowledge  of  the  subject. 

We  can  in  the  further  consideration  of  this  subject 
do  little  more  than  define  the  principal  sorts  of  insanity ; 
and  we  desire  here  generally  to  express  our  indebtedness 
in  this  respect  to  the  manual  of  Dr.  Spitzka,  to  whose 
work  we  refer  the  reader  for  detailed  descriptions  of  the 
different  types  of  insanity. 

Mania  is  a  form  of  insanity  characterized  by  an 
exalted  emotional  state,  which  is  associated  with  a  cor- 
responding exaltation  of  other  mental  and  nervous 
functions. 

The  typical  condition  of  the  maniac  may  be. summa- 
rized in  one  phrase,  —  loosening  of  the  inhibitions,  or 
checks,  both  of  organic  and  of  mental  life.  The  percep- 
tions appear  more  acute ;  the  associations  are  quick,  so 
rapid,  indeed,  that  the  ease  with  which  the  patient  forms 
new  and  extravagant  combinations,  and  the  readiness  with 
which  novel  suggestions  present  themselves,  impress  the 
novice  as  manifestations  of  a  naturally  quick  wit,  or  of  a 
talented  and  original  mind.  Illusions  are  frequent,  and 
hallucinations  sometimes  present.  With  the  excitement 
in  the  sensorial,  intellectual,  and  vegetative  spheres, 
there  develops  a  corresponding  condition  of  the  motor 
apparatus.  Sometimes  no  furious  stage  is  developed, 
and  hallucinations  are  absent.  The  outbreak  of  mania 
is  rarely,  if  ever,  sudden  or  rapid  ;  its  duration  varies,  an 
average  case  having  an  initial  stage  of  depression  lasting 
about  six  weeks,  a  maniacal  period  of  about  three 
months,  while  the  period  of  convalescence  will  occupy 
about  a  fortnight.  Its  prognosis  is  very  favorable. 


344  MEDICAL  JURISPRUDENCE. 

Melancholia  is  a  form  of  insanity  whose  essential  and 
characteristic  feature  is  a  depressed,  that  is,  subjectively 
arising  painful  emotional  state,  which  may  be  associated 
with  a  depression  of  other  nervous  functions.  At  its 
height  it  is  the  antithesis  of  mania.  The  common  basis 
upon  which  the  symptoms  in  all  melaucholiacs  develop 
is  the  subjective  painful  emotion.  Unsystematized  de- 
lusions of  a  depressive  nature  are  the  most  common 
symptoms.  The  delusions  of  the  melancholiac  may  be 
modified  by  sensory  disturbances,  such  as  neuralgias, 
anaesthesias,  or  disordered  smell  and  taste.  Hallucina- 
tions are  very  common. 

At  some  stages  in  the  disorder  the  patient  may  be- 
come restless  from  fear,  and  spurious  states  of  fury  may 
thereby  be  developed.  In  mania  the  outbreak  is  the 
result  of  an  expansive  or  angry  emotion ;  while  in 
melancholia,  the  outbreak  best  known  as  melancholic 
frenzy  is  the  outcome  of  an  anxious  terror.  This  mel- 
ancholic frenzy  is  of  shorter  duration  than  maniacal 
furor,  and  unlike  the  latter,  it  terminates  suddenly. 

The  average  duration  of  melancholia  is  from  three  to 
eight  months,  although  it  may  last  years.  Its  prognosis 
is  less  favorable  than  that  of  mania,  although  about  six 
out  of  ten  patients  completely  recover. 

Katatonia  is  a  form  of  insanity  characterized  by  a 
pathetical  emotional  state,  and  verbigeration,  combined 
with  a  condition  of  motor  tension.  According  to 
Dr.  Hammond,  it  is  characterized  by  alternate  periods, 
supervening  with  more  or  less  regularity,  of  acute  mania, 
melancholia,  and  epileptoid  and  cataleptoid  states,  with 
delusions  of  an  exalted  character  and  a  tendency  to 
dramatism.  Its  most  striking  phenomena  are  its  cata- 


INSANITY.  345 

leptoid  periods.  Its  prognosis  is  favorable  as  regards 
life. 

Transitory  frenzy  is  a  condition  of  impaired  conscious- 
ness characterized  by  either  an  intense  maniacal  fury  or 
a  confused  hallucinatory  delirium,  whose  duration  does 
not  exceed  a  period  of  a  day  or  thereabouts.  This 
condition  is  designated  by  some  observers  as  transitory 
mania,  by  others  transitory  melancholia ;  others  have 
classed  it  among  epileptic  disorders.  Dr.  Spitzka 
prefers  the  term  "transitory  frenzy,"  in  view  of  the 
specific  feature  of  amnesia,  and  because  this  term  com- 
mits to  no  doubtful  hypothesis  and  best  expresses  the 
leading  symptom  of  the  disorder.  It  is  a  comparatively 
rare  affection.  Insolation,  prolonged  insomnia,  exposure 
to  extreme  cold,  violent  emotional  and  intellectual  strain, 
have  frequently  been  determined  to  have  been  the  ex- 
citing causes. 

Stuporous  insanity  consists  in  the  simple  impairment 
or  suspension  of  the  mental  energies,  unmarked  by  any 
emotional  or  other  perversion.  At  the  height  of  this 
disorder  the  patient  is  in  a  state  of  immobility,  and 
does  nothing  of  his  own  initiative.  Sensibility  is  im- 
paired as  much  as  mobility ;  the  reflex  acts  are  some- 
times greatly  impaired;  the  pupils  are  dilated,  and 
react  poorly ;  the  pulse  is  tardy,  small,  and  frequent ; 
the  temperature  slightly  lowered;  the  extremities  are 
cold,  while  oedema  of  the  feet  is  constantly,  and  of  the 
hands  and  face  sometimes,  observed ;  mental  activity 
shares  in  the  depression,  and  abolition  of  other  ner- 
vous and  general  somatic  functions.  The  stuporous 
lunatic's  recollection  of  the  period  of  his  illness  is  en- 
tirely destroyed. 


346  MEDICAL  JURISPRUDENCE. 

This  disease  may  run  its  course  in  a  few  weeks,  but 
its  usual  duration  is  from  one  to  three  months.  Its 
prognosis  is  highly  favorable,  nine-tenths  of  the  pa- 
tients recovering.  This  disorder  is  known  in  English 
and  American  asylums  as  acute  or  primary  dementia. 

Primary  confusional  insanity  is  a  form  of  mental  de- 
rangement characterized  by  incoherence  and  confusion 
of  ideas,  without  any  essential  emotional  disturbance  or 
true  dementia.  This  disorder  is  rare,  and  develops 
rapidly  on  a  basis  of  cerebral  exhaustion.  Patients  suf- 
fering from  this  disease  after  a  rapid  rise  of  their  symp- 
toms during  a  period  of  incubation  rarely  exceeding 
a  few  days,  present  hallucinations  arid  delusions  of  a 
varied  and  contradictory  character.  Delusions  of  iden- 
tity are  very  common.  The  speech  of  the  patient  is 
characteristic;  sentences  are  left  incomplete,  and  are 
entirely  irrelevant  as  well  as  incoherent.  Eecovery  is 
gradual ;  in  only  a  small  proportion  of  cases  does  the 
insanity  remain  and  the  patient  become  permanently 
deteriorated,  his  disorder  then  constituting  a  form  of 
chronic  confusional  insanity. 

Primary  mental  deterioration  is  an  uncomplicated 
enfeeblement  of  the  mind,  occurring  independently  of 
the  developmental  and  involutional  periods.  In  most 
persons  surviving  their  sixtieth  year,  a  pronounced  and 
general  failure  of  the  mental  powers  occurs  at  or  after 
that  period ;  this  is  the  ordinary  senile  change  and 
cannot  be  considered  in  all  cases  pathological;  but 
where  a  similar  deterioration  anticipates  the  senile 
period,  it  can  only  be  accounted  for  on  a  pathological 
basis.  Such  a  decay  of  mind  is  observed  in  paretic, 
syphilitic,  and  organic  dementia,  and  is  also  found  to 


INSANITY.  347 

be  the  sequel  of  numerous  other  forms  of  insanity.  In 
all  these  cases  the  mental  failure  is  accompanied  by 
active  symptoms  characterizing  the  given  variety  of 
mental  disorder. 

In  primary  mental  deterioration,  however,  progressive 
deterioration  is  chiefly  limited  to  the  higher  mental 
faculties,  and  is  the  only  notable  indication  of  cerebral 
disturbance.  The  patient  experiences  a  lack  of  energy 
both  mental  and  physical;  finds  it  difficult  to  go  to 
sleep ;  there  is  an  irritable  condition  of  the  brain  mani- 
festing itself  in  dreams;  the  patient  becomes  dyspep- 
tic, and  there  may  be  signs  of  functional  or  organic 
heart  disorder,  or  of  the  prodromal  period  of  Bright's 
disease.  At  this  stage  a  comparatively  healthful  men- 
tal state  may  be  regained  by  rest  and  proper  treatment ; 
but  if  the  exciting  causes,  which  are  principally  excite- 
ment and  mental  strain,  are  kept  in  operation,  actual 
dementia  may  follow.  There  are  no  delusions  or  mor- 
bid propensities,  although  there  may  be  occasionally  a 
suicidal  tendency.  Complete  rest  and  proper  tonic  and 
moral  treatment  will  check  the  disease  at  any  but  its 
later  periods ;  but  a  complete  restoration  to  the  pa- 
tient's former  condition,  Dr.  Spitzka  says  he  has  never 
observed,  even  the  most  favorable  cases  revealing  some 
permanent  damage. 

Secondary  and  Terminal  Deterioration.  —  In  certain 
cases  of  mania,  melancholia,  stuporous,  and  other  pri- 
mary forms  of  insanity,  while  death  does  not  ensue,  the 
patient  does  not  recover,  but  a  secondary  and  chronic 
psychosis  develops  from  the  primary  disease.  Terminal 
dementia  is  the  ordinary  conclusion  of  most  chronic 
and  uncured  acute  insanities.  Numerous  grades  and 


348  MEDICAL  JURISPRUDENCE. 

varieties  of  this  affection  exist,  and  it  is  customary  in 
characterizing  these  varieties  to  state  the  primary  form 
which  preceded  them.  The  residua  of  the  delusions  of 
primary  insanity  may  sometimes  be  detected. 

Dementia  must  not  be  confounded  with  imbecility. 
While  both  dementia  and  imbecility  imply  a  profound 
defect  in  the  mental  sphere,  the  former  term  should 
always  be  limited  to  acquired  imbecility,  and  the  latter 
to  original  feeblemindedness  due  to  foetal  or  infantile 
arrested  development.  The  fundamental  feature  of  ter- 
minal dementia  is  an  acquired  mental  defect,  which 
may  vary  from  mere  loss  of  memory,  usually  of  recent 
events,  or  of  the  reasoning  power,  to  a  nearly  complete 
extinction  of  mind,  and  a  reduction  of  the  patient  to  a 
mere  vegetative  existence. 

Senile  dementia 1  is  a  progressive  and  primary  dete- 
rioration of  the  mind  connected  with  the  period  of 
involution,  but  exceeding  the  ordinary  extent  of  such 
involution  to  a  pathological  degree.  It  is  characterized 
by  an  increased  egotism  or  by  penuriousness,  enfeeble- 
ment  of  memory,  prejudices  formed  on  trivial  or  no 
ground,  and  frequently  a  profound  moral  deterioration. 
Unsystematized  ambitious  delusions  are  sometimes  pres- 
ent, although  the  majority  have  depressive  delusions, 
chiefly  in  respect  to  their,  property.  Hallucinations 
and  illusions  may  exist. 

Should  no  other  intercurrent  illness  cut  short  the 
course  of  the  disease,  bed-sores  and  colliquative  diar- 
rhoeas, complicated  sometimes  with  diseases  of  the 
bladder,  terminate  the  patient's  life.  If  the  patient 
lives  long  enough,  complete  fatuity  results,  when  he 

1  Senile  dementia  and  senile  insanity  are  not  convertible  terms. 


INSANITY.  349 

may  become  voracious  and  filthy,  to  die  finally  with 
apoplectiform  symptoms,  or  with  those  of  a  gradual  and 
general  paralysis. 

Insanity  of  pubescence  (hebephrenia)  is  characterized 
by  mental  enfeeblement  marked  by  a  silly  disposition, 
following  a  primary  period  of  depression  which  has  the 
same  tinge  as,  but  without  the  depth  of,  that  character- 
izing melancholia,  and  which  coincides  with  or  follows 
the  period  of  puberty.  It  occurs  between  the  fifteenth 
and  twenty-second  year,  and  begins  with  a  period  of 
sadness  without,  however,  the  depth  of  depressive  emo- 
tion of  melancholia,  and  in  the  midst  of  which  there 
may  be  sudden  outbursts  of  causeless  laughter  or  silly 
jokes.  After  this  preliminary  period  the  patients  may 
exhibit  vague  or  blind  propensities;  have  no  settled 
aim,  or  may  display  stupid  malice  towards  their  sur- 
roundings. While  there  is  no  incoherence  there  is  a 
peculiar  tendency  to  verbosity  and  the  use  of  long 
words  or  such  as  have  an  odd  sound,  etc.  The  in- 
tellect weakens  progressively  and  the  patient,  who  is 
usually  a  confirmed  masturbator,  gradually  passes  into 
a  terminal  dementia.  Everything  connected  with  the 
mental  state  of  these  patients  appears  shallow  and  even 
unreal. 

The  course  of  this  form  of  insanity  is  protracted,  and 
its  prognosis  exceedingly  unfavorable.  Many  of  the 
cases  are  still  classed  as  primary  dementia,  particularly 
when  the  deterioration  is  very  rapid.  Where  masturba- 
tion is  a  pronounced  feature,  some  writers  use  the 
designation  "  insanity  of  masturbation." 

Paretic  Dementia.  —  The  cases  of  insanity  thus  far  de- 
scribed have  been  those  whose  essential  characteristics 


350  MEDICAL  JURISPRUDENCE. 

are  the  mental  symptoms  proper.  We  now  come  to  a 
second  class  of  cases,  in  which  there  are  demonstrable 
active  organic  changes  of  the  brain.  The  first  of  these 
diseases  to  which  we  shall  refer  is  paretic  dementia,  a 
disease  presenting  so  many  diverse  symptoms  and  char- 
acteristics that  we  cannot  hope,  with  the  limited  space  at 
our  disposal,  to  describe  it  with  anything  like  complete- 
ness. It  is  characterized  in  its  full  development  by  a 
combination  of  mental  and  somatic  deteriorations ;  the 
brain  and  the  spinal  cord  of  patients  dying  with  this 
disease,  show  the  results  of  long  continued  and  often 
intense  degenerative  morbid  processes,  which  many 
authors  regard  as  of  an  inflammatory  character.  The 
brain  itself  is  found  to  be  wasted,  —  not  uniformly  so, 
however,  but  to  a  more  marked  degree  in  some,  and  to  a 
less  marked  degree  in  other  districts.  A  very  frequent 
appearance  in  advanced  paretic  dementia  is  C3rstic  de- 
generation of  the  cortex  of  the  brain.  But  for  details 
upon  this  subject  reference  is  made  to  Chapter  XIII.  of 
Dr.  Spitzka's  manual. 

The  mental  symptoms  of  this  disease  generally  pre- 
sent the  picture  of  unsystematized  ambitious  delusions, 
combined  with  progressive  paresis  and  dementia ;  they 
may  range,  however,  from  atonic  depression  to  the  most 
furious  delirium ;  from  the  construction  of  fanciful  pro- 
jects to  extreme  incoherency;  from  slight  and  almost 
undemonstrable  mental  impairment  to  the  absolute  ex- 
tinction of  higher  mental  life.  The  physical  signs  may 
vary  from  a  slight  disturbance  of  speech  to  gross 
paralysis,  or  may  present  themselves  under  the  mask 
of  a  posterior  spinal  sclerosis  (locomotor  ataxia),  of  a 
disseminated  organic  disease,  or  of  apoplectiform  and 


INSANITY.  351 

epileptiform  seizures.  Among  the  individual  signs 
there  may  be  found  almost  any  and  every  focal  and 
general  symptom  known  to  the  neurologist:  paresis 
of  various  voluntary  and  involuntary  muscles  ;  anaesthe- 
sias, parresthesias,  hypersesthesias,  pains,  and  trophic 
disturbances  ;  changes  in  the  vascular  tone ;  amblyopia, 
hemiopia,  color-blindness,  aphasia,  choreiform  and  athe- 
toid  movements;  progressive  muscular  atrophy  ;  pseudo- 
hypertrophic,  and  bulbar  paralysis.  All  these  may  be 
found  co-existent  with  the  mental  disorder  and,  indeed, 
depending  on  the  same  morbid  process. 

The  mental  symptoms  of  the  prodromal  period  are 
attributable  to  simple  brain  failure ;  the  attention  is  not 
readily  aroused ;  amnesia  is  noted  from  the  beginning ; 
there  is  more  or  less  moral  deterioration ;  there  is  a  mor- 
bid irritability  on  slight  provocation;  simultaneously 
with  this  moral  deterioration  is  a  disturbance  of  the  will 
and  emotional  natura 

In  the  active  phase  there  are  marked  exacerbations 
of  the  physical  signs ;  there  are  defects  in  the  movement 
of  the  tongue  and  lips,  so  that  the  patient  finds  it  difficult 
to  pronounce,  particularly  the  explosive  and  hissing 
sounds.  A  most  characteristic  feature  is  the  association 
of  other  normally  unnecessary  movements  with  those  of 
the  lips  and  tongue  ;  there  is  a  tremor  at  the  angles  of 
the  mouth ;  alternate  dilation  and  contraction  of  tlie  nos- 
trils ;  corrugation  of  the  eye-brows,  etc.,  after  which  the 
word  is  thrown  out  precipitately.  With  these  speech 
innervations  all  the  finer  motor  co-ordinations  seem  to 
suffer.  The  depressive  moods  of  the  patient  and  com- 
plaints about  head  symptoms,  if  they  existed,  usually 
disappear  about  this  time.  Unsystematized  delusions 


352  MEDICAL  JURISPRUDENCE. 

of  grandeur  appear,  and  are  often  joined  with  morbid 
projects  and  extravagant  expenditures.  Trophic  dis- 
turbances and  all  the  motor  disturbances  become  more 
and  more  marked ;  bed-sores,  furuncles,  diarrhoeas,  pul- 
monary gangrene,  etc.,  may  supervene.  Apoplectiform 
or  epileptiform  seizures  sometimes  mark  the  course  of 
the  disorder  from  the  beginning,  to  which  the  patient 
may  finally  succumb. 

The  delusions  of  paretic  dements  although  usually  are 
not  always  expansive,  but  on  the  contrary  may  be  de- 
pressive in  their  nature.  Hallucinations  and  illusions 
sometimes  exist. 

There  are  three  sorts  of  episodical  attacks  to  which 
paretic  dements  are  subject,  which  are  among  the  most 
important  signs  of  this  disease,  and  which  from  their 
resemblance  to  maniacal  delirium,  epileptic  fits,  and 
apoplectic  diseases,  are  called,  respectively,  maniacal, 
epileptiform,  and  apoplectiform,  attacks  of  paretic  de- 
mentia. For  a  particular  description  of  these,  the  reader 
is  referred  to  Dr.  Spitzka's  manual. 

The  prognosis  of  paretic  dementia  is  very  bad ;  there 
are,  however,  a  few  cases  where  there  appears  to  have 
been  a  permanent  recovery.  The  duration  of  the  dis- 
ease is  commonly  within  three  years,  and  in  some  cases 
it  may  terminate  as  soon  as  six  months,  although  in 
other  cases  the  disease  may  continue  for  six,  or  even  ten 
years. 

Syphilitic  dementia  bears  a  strong  resemblance  to  pare- 
tic dementia,  and  to  dementia  from  organic  brain  dis- 
ease. In  this  disease  demonstrable  brain  lesions,  standing 
in  constant  relation  to  the  symptoms,  are  found  in  a  ma- 
jority of  cases.  It  is  not  always  possible,  clinically,  to 


INSANITY.  353 

make  a  sharp  discrimination  between  syphilitic  de- 
mentia and  paretic  dementia  proper;  syphilis  plays  a 
prominent  role  in  the  etiology  of  the  latter  affection. 
Delusions  are  not  prominent  and  are  rarely  expansive. 
After  a  prodromal  period  the  course  of  the  disease  pro- 
gresses very  slowly  towards  a  fatal  termination. 

Delirium  grave  is  a  comparatively  rare  form  of  de- 
rangement, approximating  in  many  respects  to  maniacal 
delirium.  It  has  been  variously  termed,  typhomania, 
mania  gravis,  phrenitis,  and  acute  delirium.  It  is 
preceded  and  undoubtedly  caused  by  profound  nervous 
or  physical  exhaustion  and  over-strain.  Its  mental 
symptoms  resemble  the  highest  degrees  of  maniacal 
furor  and  melancholic  frenzy,  but  differ  from  these  states 
in  their  mode  of  development,  in  that  the  outbreak  of 
grave  delirium  is  either  sudden  or  preceded  by  a  state 
of  impaired  consciousness  of  a  kind  not  found  in  mania 
or  melancholia  proper.  The  ideation  of  grave  delirium 
is  much  more  incoherent  than  that  of  frenzy,  and  is 
usually  the  expression  of  an  angry  or  frightened  state. 
At  the  outset  the  patient  may  still  articulate  sentences, 
but  his  speech  rapidly  deteriorates  and  he  is  finally  un- 
able to  pronounce  syllables.  The  patients  appear  to 
be  afflicted  with  hallucinatory  visions,  of  'the  day  of 
judgment,  of  conflagrations,  of  bloody  scenes,  or  of  those 
connected  with  the  exciting  cause.  There  is  great  rest- 
lessness ;  sometimes  there  are  rhythmical  motions ;  in 
many  cases  there  is  absolute  insomnia. 

The  second  period  of  the  disease  is  analogous  to  the 
post-maniacal  reaction  following  the  outbreak  of  simple 
mania ;  there  is  now  extreme  mental  and  physical  de- 
pression. If  the  patient  does  not  die  in  this  condition, 

23 


354  MEDICAL  JURISPRUDENCE. 

he  passes  into  a  state  resembling  convalescence  from 
typhus,  without  the  favorable  termination  of  the  latter. 
The  majority  of  patients  afflicted  with  this  disease  die 
in  a  delirious  state  within  a  few  weeks.  In  those  who 
do  not  die  within  this  period  the  excitement  continues 
without  abatement  four  or  five  weeks,  and  the  case  ends 
with  fatal  coma.  Complete  recovery  rarely  occurs :  in 
rare  instances  the  patients  emerge  from  the  disease  with 
a  slight  mental  defect ;  in  other  cases  paretic  and  ter- 
minal dementia  supervene. 

Chronic  Alcoholic  Insanity.  —  Insanity  resulting  from 
alcoholic  excesses  ordinarily  belongs  to  groups  already  de- 
scribed. The  various  states  of  drunkenness  and  delirium 
tremens  are  not  ordinarily  considered  insanity.  There 
are  also  various  forms  of  dementia  depending  on  organic 
changes  produced  by  alcohol  in  the  bruin  and  its  mem- 
branes which  pertain  to  the  group  of  dementia  from 
organic  disease.  Just  as  epileptic  and  hysterical  in- 
sanity may  develop  from  the  epileptic  or  hysterical 
neuroses,  so  a  special  form  of  alcoholic  insanity  may 
become  engrafted  on  the  alcoholic  neurosis.  It  has  dis- 
tinct clinical  characters,  and  is  called  chronic  alcoholic 
insanity. 

On  the  chronic  alcoholic  constitution  as  a  background, 
with  which  most  readers  are  sufficiently  familiar,  is 
developed  the  psychosis  of  chronic  alcoholic  insanity. 
After  a  brief  prodromal  period,  marked  by  congestive 
attacks  and  headaches,  and  under  the  influence  of  fright- 
ful hallucinations,  chiefly  of  visions,  the  patient  becomes 
the  subject  of  delusions  of  persecutions,  to  which  are 
rarely  added  expansive  delusions.  The  persecutory  de- 
lusions of  alcoholism  relate  to  the  sexual  organs,  sexual 


INSANITY.  355 

relations,  and  to  poisons.  Many  inebriates  entertain  also 
delusions  of  marital  infidelity.  Delirious  exacerbations 
are  likely  to  occur  in  consequence  of  the  patient's  mor- 
bid fear.  Similar  hallucinations  to  those  found  in  acute 
alcoholic  delirium  may  exist ;  the  patient  may  see  snakes, 
insects,  dead  bodies,  mocking  faces,  etc.  There  is  quite 
constantly  more  or  less  disturbance  of  the  memory,  and 
occasionally  there  is  stupor. 

The  prognosis  is  very  unfavorable,  and  there  is  a  clear 
tendency  to  dementia. 

Chronic  Hysterical  Insanity.  —  The  forms  assumed  by 
hysteria  are  so  manifold  that  anything  like  even  a  full 
enumeration  of  them  would  be  impossible.  So  with 
chronic  hysterical  insanity.  Its  symptoms  are  various  ; 
the  patients  are  changeable,  emotional,  fretful,  careless, 
and  superficial  in  their  behavior  and  thoughts,  extremely 
egotistical,  and  desirous  of  notoriety  or  sympathy,  or 
both.  To  be  the  sufferer  from  an  equally  interesting, 
rare,  and  hopeless  nervous  disease  is  the  ambition  of 
some ;  to  be  considered  the  most  abused  woman  on 
earth  is  the  ambition  of  others.  A  patient  with  this 
hysterical  character  may  develop  psychoses  quite  analo- 
gous to  those  found  in  epileptic  and  alcoholic  patients. 
There  may  be  a  transitory  hysterical  psychosis  mani- 
festing itself  in  deliria  of  fear  ;  so  we  may  have  maniacal 
and  melancholic  states.  The  psychosis  in  hysteria  may 
be  protracted  in  duration,  as  in  the  alcoholic  disorder. 
There  is  a  tendency  to  simulate  a  theatrical  behavior ; 
there  is  an  intensification  of  the  hysterical  character, 
to  which  is  frequently  added  a  silly  mendacity.  Sexual 
ideas  are  common,  and  manifested  in  two  opposite  ex- 
tremes ;  hallucinations  are  frequent ;  in  some  patients 


356  MEDICAL  JURISPRUDENCE. 

obstinate  mutism  is  observed,  which  by  skilful  cross- 
questioning  will  be  found  to  be  wilful. 

A  few  cases  of  hysterical  insanity  and  hystero- epilepsy 
in  males  have  been  described. 

The  prognosis  of  this  form  of  insanity  is  unfavorable 
as  to  lasting  recovery. 

Epileptic  Insanity.  —  Aside  from  epileptic  dementia,  a 
mental  degeneration  intimately  dependent  on  the  fre- 
quency of  the  convulsive  attacks,  and  which  may  deter- 
mine stupor,  imbecility,  or  actual  idiocy,  according  as 
these  attacks  begin  later  or  earlier  in  life,  —  aside  also 
from  those  attacks  of  furious  madness  replacing  the  con- 
vulsive attack,  and  which  may  be  regarded  as  psychical 
equivalents  of  the  convulsions,  —  there  are  forms  of 
more  or  less  protracted  insanity  following  some  indi- 
vidual epileptic  attack,  or  breaking  out  in  the  interval,  or 
finally  extending  over  the  entire  interval,  which  are  to 
be  distinguished  from  the  above  forms. 

Acute  post-epileptic  insanity  may  take  the  form  of 
simple  post-epileptic  stupor,  which  may  be  complicated 
with  dreamy  deliria  or  with  illusional  or  hallucinatory 
confusion  and  verbigeration ;  or  post-epileptic  morbid 
conditions  of  fear  or  fright,  either  simple  or  complicated 
with  delire  raissonante  or  great  excitement;  or  post- 
epileptic  maniacal  moria,  —  a  rare  form,  which  closely 
simulates  ordinary  acute  mania.  There  are  also  cases 
of  chronic  protracted  epileptic  insanity  closely  related 
to  the  post-epileptic  forms. 

Dr.  Spitzka  suggests  the  following  chronological  classi- 
fication of  epileptic  insanity :  — 

1.  The  epileptic  psychical  equivalent  which  replaces 
the  convulsive  attack. 


INSANITY.  357 

2.  The   acute    post-epileptic   insanity  which   almost 
immediately  follows  the  convulsive  attack. 

3.  The  pre-epileptic  insanity  which  precedes  the  out- 
break of  the  convulsive  attack  or  its  equivalent,  and 
increases    up    to    the    moment   when    the    paroxysm 
explodes. 

4.  The  purely  intervallary  epileptic  insanity  which, 
neither  immediately  following  nor  preceding  a  paroxysm, 
occurs  in  the  interval  between  such. 

Dr.  Spitzka  says  it  is  possible  for  all  these  forms  to 
occur  together,  and  in  addition  there  is  very  apt  to  be 
a  background  of  protracted  epileptic  dementia ;  it  is  only 
where  epilepsy  is  recent  that  the  above  forms  are  found 
in  an  unmixed  state. 

The  immediate  prognosis  of  epileptic  insanity  is  favor- 
able as  regards  the  more  acute  explosions ;  the  protracted 
forms  are  sometimes  recovered  from,  but  mental  en- 
feeblement  is  more  likely  to  ensue  than  in  the  former 
case. 

Periodical  Insanity  is  characterized  by  the  recurrence 
of  mental  disorder  at  more  or  less  regular  intervals,  the 
attacks  being  separated  by  periods  during  which  the 
patient  presents  a  state  of  apparent  mental  soundness. 
An  important  characteristic  of  periodical  insanity  is  the 
similarity  of  the  manifestations  of  the  different  attacks 
in  the  same  patient  for  long  periods.  The  intervals 
between  these  attacks  are  not  always  entirely  lucid,  but 
rather  sub-lucid.  It  may  take  the  form  of  periodical 
mania  or  periodical  melancholia.  ' 

Periodical  insanity  does  not  always  manifest  itself 
under  the  guise  of  a  single  form  of  derangement.  There 
is  a  subdivision,  known  as  Circular  Insanity,  character- 


358  MEDICAL  JURISPRUDENCE. 

ized  by  the  alternation  of  mania  and  melancholia  in 
regularly  recurring  cycles,  the  order  of  which  varies  in 
different  patients.  As  a  rule,  the  mania  and  melancho- 
lia correspond  to  each  other  in  intensity,  and,  generally, 
the  shorter  the  cycle  the  more  intense  the  symptoms 
and  the  better  the  prognosis.  Circular  insanity  gen- 
erally begins  at  or  about  the  age  of  puberty,  and, 
like  other  periodical  insanities,  is  more  frequent  with 
females  than  with  males,  is  intractable  to  treatment, 
and  while  not  ordinarily  leading  to  dementia,  some 
mental  deterioration  sooner  or  later  is  manifested. 

The  States  of  Arrested  Development.  —  Under  this 
head  are  included  the  conditions  known  as  idiocy,  im- 
becility, and  cretinism.  They  are  usually  divided  into 
three  grades :  a  subject  deprived  of  all  higher  mental 
power,  and  who  is  unable  to  acquire  the  simplest  ac- 
complishments is  termed  an  idiot ;  one  who  is  capable 
of  acquiring  the  simplest  accomplishments,  but  who  is 
unable  to  exercise  the  reasoning  power  beyond  the  ex- 
tent to  which  a  child  is  capable,  is  termed  an  imbecile; 
finally,  there  is  a  large  class  of  subjects  who  are  de- 
fective in  judgment,  and  in  whom  this  defect  is  of  simi- 
lar origin  to  —  though  not  as  intense  as  —  that  of  the 
imbecile  and  idiot.  These  classes  are  not  separated  by 
any  distinct  margin  of  demarcation,  but  shade  indef- 
initely from  one  class  to  the  other. 

In  idiocy  there  is  usually,  besides  the  mental  defect, 
some  deficiency  in  the  peripheral  organs  or  their  func- 
tions. Many  idiots  are  deaf  or  mute,  or  both;  some 
are  blind,  and  anaesthesia  as  well  as  anosmia  has  been 
observed.  They  learn  to  walk  late  or  not  at  all ;  the 
skeleton  is  usually  poorly  developed ;  rachitis  is  com- 


INSANITY.  359 

mon,  and  the  somatic  functions  are  generally  imperfectly 
performed ;  the  sexual  organs  particularly  are  found  to 
be  rudimentary  or  deformed,  and  the  sexual  function 
is  usually  in  abeyance  in  idiots,  although  this  is  not 
always  the  case.  The  imitative  tendencies  in  idiots 
are  often  very  strong;  in  imbeciles  they  may  be  util- 
ized to  make  good  artisans.  In  the  lowest  forms  of 
idiocy  speech  may  be  altogether  absent  or  limited  to 
a  few  inarticulate  sounds;  in  others,  a  few  words  or 
short  sentences  may  be  acquired.  Idiots  rarely  reach 
maturity. 

The  mental  state  of  the  imbecile  has  been  very  well 
expressed  by  the  statement  that  "those  mental  co- 
ordinations acquired  in  the  course  of  a  higher  civiliza- 
tion have  not  been  formed  in  him."  While  defective 
as  to  reasoning  capacity,  his  emotional  state  may  present 
every  analogy  to  that  of  healthy  persons  or  approxi- 
mate that  of  other  forms  of  insanity.  Moral  defect  is 
a  prominent  feature  of  some  cases.  In  Dr.  Spitzka's 
opinion  the  term  "  moral  insanity  "  of  authors  should  be 
limited  to  this  class  of  subjects,  and  a  much  better  term 
to  use  would,  in  his  opinion,  be  "  moral  imbecility." 

Morbid  projects,  imperative  impulses,  and  morbid 
egotism  are  common  in  some  imbeciles,  and  in  such 
cases  it  may  be  difficult  to  decide  whether  they  pertain 
to  the  group  of  imbecility  or  of  original  monomania. 

Both  imbecility  and  idiocy  are  sometimes  marked  by 
other  disturbances  of  the  nervous  functions  than  those 
comprised  in  the  mind.  Epilepsy  is  common ;  spastic 
symptoms,  contractures,  strabismus,  peculiar  speech- 
defects,  and  stuttering  sometimes  exist.  The  condi- 
tion of  idiocy  and  imbecility  is  usually  a  stable  one, 


360  MEDICAL  JURISPRUDENCE. 

although  occasionally  progressive  deterioration  is  caused 
by  epileptic  fits. 

The  mental  phenomena  of  cretinic  idiocy  are  like 
those  of  ordinary  idiocy.  For  further  description  of 
this  subject  the  reader  is  referred  to  Dr.  Spitzka's  Work, 
and  to  other  treatises  on  nervous  and  mental  diseases. 

Paranoia  (Monomania)  —  Monomania,  as  it  has  hitherto 
usually  been  called,  or  as  Dr.  Spitzka  now  terms  it, 
"  paranoia,"  is  a  chronic  form  of  insanity  based  on  an  ac- 
quired or  transmitted  neuro-degenerative  taint,  and  mani- 
festing itself  in  anomalies  of  the  conceptional  sphere, 
which,  while  they  do  not  destructively  involve  the 
entire  mental  mechanism,  dominate  it. 

The  symptoms  of  classical  paranoia  may  be  numerous 
or  varied,  or  they  may  be  few  or  limited  in  range.  In 
some  patients,  usually  encountered  without  asylums,  a 
single  imperative  conception  or  impulse,  or  a  delusive 
suspicion  which  may  never  become  organized  into  an 
insane  belief,  may  be  the  sole  mental  symptom.  De- 
lusional monomania  is  the  most  frequent  form  of  this 
disorder.  The  delusions  of  this  form  of  monomania 
are  alone  sufficient  to  characterize  the  disorder,  and 
when  found  serve  to  establish  the  diagnosis.  They  are 
of  the  systematized  variety.  Delusions  of  persecution 
are  the  most  common  ones ;  hallucinations,  particularly 
of  hearing,  are  very  common.  Their  beliefs  are  almost 
as  numerous  as  the  patients,  but  are  all  characterized 
by  the  feature  that  the  occurrences  in  the  outer  world 
are  anxiously  examined  by  the  patient  with  a  view  of 
tracing  their  connection  with  himself.  Sometimes,  as 
the  result  of  inward  reflection  and  reasoning,  there  is 
a  rapid  transformation  of  the  delusions  of  persecution 


INSANITY.  361 

into  those  of  aggrandizement.  The  varieties  are  nu- 
merous. (For  details  see  the  larger  treatises  upon  In- 
sanity and  Medical  Jurisprudence.) 

The  outbreak  of  the  disorder  usually  coincides  with 
some  one  of  the  physiological  periods,  such  as  puberty, 
the  second  climacteric,  pregnancy,  and  the  puerperal 
state.  It  is  sometimes  precipitated  by  sexual  excesses, 
and  occasionally  by  visceral  disease  and  fevers. 

The  prognosis  is  very  unfavorable.  The  disease, 
when  not  cured,  remains  stationary  for  years.  Mental 
deterioration,  however,  does  not  proceed  rapidly,'  and 
never  reaches  the  degree  of  chronic  confusional  insanity 
or  terminal  dementia  unless  there  is  some  intercurrent 
disease. 

Simulation  of  Insanity.  —  Insanity  may  be  simulated 
by  ignorant  persons,  or  by  persons  who  have  had  more  or 
less  opportunity  for  observing  or  studying  the  disease. 
In  the  former  case  detection  is  easy ;  in  the  latter  it 
is  more  difficult,  and  there  are  recorded  instances  where 
competent  observers  have  been  deceived  by  simulators. 
(See  instances  narrated  by  Dr.  Spitzka:) 

A  common  test  with  some  persons  is  that  the  simu- 
lator does  not  repudiate  his  insanity  as  does  the  truly 
insane  person.  Aside  from  the  fact  that  the  insane  do 
sometimes  recognize  their  condition  and  exceptionally 
admit  it,  this  criterion  is  at  present  entirely  worthless, 
for  the  reason  that  many  simulators  now  know  that  it 
is  by  some  considered  as  a  test,  and  govern  their  actions 
accordingly. 

Usually  the  observer's  attention  will  be  directed  to 
the  possibility  of  simulation  by  some  inconsistency  in 
the  clinical  picture  presented  by  the  subject.  Clearly 


362  MEDICAL  JURISPRUDENCE. 

marked  cases  of  different  kinds  of  insanity  before  de- 
scribed, are  very  difficult  to  feign  correctly  in  every 
feature,  and  the  simulator,  through  ignorance,  will  not 
unfrequently  confound  different  types  of  disease  and 
thus  disclose  the  fraud.  But  there  are  some  obscure 
and  mixed  groups  not  easily  recognized,  in  which  a  skil- 
ful simulator  may  succeed  in  imposing  upon  even  a 
competent  observer. 

The  existence  or  non-existence  of  a  motive  for  simu- 
lation will  often  throw  much  light  upon  the  subject. 
The '  simulator,  by  his  adoption  of  the  popular  idea  of 
insanity,  that  the  insane  are  either  raving  and  inco- 
herent, at  all  times  and  on  all  points,  or  in  a  condition 
of  fatuity,  will  thereby  frequently  reveal  the  fact  of 
simulation.  A  knowledge  of  the  clinical  features  of 
the  different  sorts  of  insanity  will  usually  enable  one 
to  expose  such  simulation.  As  a  rule,  the  simulator,  in 
those  quiet  periods  following  upon  his  artificial  excite- 
ment, which  are  the  expression  of  inability  to  maintain 
the  exacting  efforts  of  simulation,  does  not  recognize  his 
friends  or  surroundings,  or  recollect  anything  that  oc- 
curred about  that  period  of  time  in  which  he  has  a 
motive  for  making  people  believe  he  was  irresponsible. 
The  true  maniac,  however,  will  be  lucid  in  these  very 
periods,  and  will  recollect  his  family  and  his  friends  per- 
fectly well ;  and  if  he  has  committed  a  crime,  while  he 
may  be  acute  enough  to  desire  to  conceal  his  recollection 
of  it,  he  will  not,  if  the  examination  is  led  up  to  the 
period  of  its  commission,  gradually  claim  to  forget  real 
circumstances  occurring  before  and  after  it,  as  does  the 
simulator.  Aside  from  toxic,  hysterical,  and  other  tran- 
sitory morbid  conditions,  it  is  only  in  epileptic  mania 


INSANITY.  3G3 

and  in  paretic  dementia  that  such  amnesia  really  oc- 
curs; but  here  the  physical  signs  or  the  history,  or 
both,  will  afford  unmistakable  evidence  of  these  affec- 
tions if  they  really  exist.  The  simulator  will  also  err 
generally  in  allowing  his  feigned  disorder  to  explode 
and  to  recede  too  rapidly. 

Another  characteristic  feature  with  many  simulators 
is  the  intensification  of  their  symptoms  when  under 
examination.  The  simulator  also  labors  under  the 
mistake  that  the  insane  do  not  reason;  too  great  a 
degree  of  incoherence  in  a  delusion  justifies  a  doubt 
of  its  genuineness.  Persons  feigning  a  quiet  sort  of 
insanity  usually  attempt  to  imitate  dementia.  The 
simulator  of  imbecility  or  dementia  either  talks  more 
confusedly  than  harmonizes  with  the  thread  of  rea- 
son he  unwarily  exhibits,  or  he  talks  less  confusedly 
than  he  should  in  the  utter  absence  of  a  connecting 
bond  in  his  thoughts  ;  in  short,  he  does  not  bal- 
ance the  defects  in  ideation  and  in  their  expression 
properly. 

The  absence  of  insomnia  and  impaired  digestion  in 
the  acute  psychoses  is  exceptional  in  real  insanity,  and 
is,  in  that  respect,  a  ground  of  suspicion.  The  simu- 
lator's task  is  rendered  difficult  whenever  he  is  kept 
under  continued  observation.  The  best  actor  may  fail 
to  adhere  to  his  assumed  character  for  days  and  nights 
in  succession. 

Dr.  Spitzka  mentions  the  following  special  signs  as 
justifying  the  suspicion  of  simulation  :  — 

1.  Studious  efforts  to  avoid  looking  at  the  physician 
upon  his  entrance. 

2.  Extravagantly  absurd  answers  to  simple  questions. 


304  MEDICAL  JURISPRUDENCE. 

3.  Taking  a  long  time  to  answer  questions,  and  hesi- 
tation in  answering. 

4.  Furtively  glancing  when  he  supposes  himself  un- 
watched  to  see  if  any  one  is  approaching  to  necessitate 
his  being  on  guard. 

5.  A    person    feigning    epileptic    and    somnambu- 
listic  states  may  recollect  perfectly  his   feigned   acts 
and  expressions,  and  carry  them  into  his  quasi-lucid 
period. 

6.  Ehythmical  movements  are  made  by  certain  simu- 
lators which  may  have  no  analogy  in  insanity  or  are 
out  of  harmony  with  the  form  of  mental  disturbance 
assumed. 

7.  Simulators  complain  much  more  about  odd  and 
painful  sensations  in  the  head  than  the  insane  usu- 
ally do. 

8.  A  clumsy  simulator  may  say,  "  I  have  the  delusion 
that  I  am  lost,"  etc.,  or,  "  I  have  hallucinations  of  faces," 
etc.      Such  a  person  can  be  readily  exposed  to  be  a 
simulator  on  other  grounds,  but  the  feature  here  men- 
tioned alone  suggests  simulation.     A  true  lunatic  may 
admit   he   has   delusions   or   hallucinations,   especially 
when  examined  for  the  purpose  of  being  committed  to 
an  asylum ;  but  when  he  does  so  he  affects  to  admit  that 
he  imagines   those  things ;    but   a  real   lunatic   never 
gives  them  names,  showing  that  he  recognizes  their 
abnormal  nature :    he  is  lost ;    he  is  pursued   by  the 
devil;  he  hears  voices,  and  he  sees  faces. 

9.  It  is  suspicious  if  insanity  appears   immediately 
after  a  crime,  or  after  an  arrest,  or  sentence,  where  its 
previous  existence  can  be  disproved. 

Among  devices  which  may  be  legitimately  resorted 


INSANITY.  365 

to  to  expose  simulation,  Dr.  Spitzka  mentions  the  fol- 
lowing :  — 

1.  When  examining  the  patient  let  the  speaker  re- 
mark in  an  undertone  to  a  by-stander,  that  if  such 
and  such  a  sign  were  present  he  would  know  in  which 
ward  to  put  him,  or  know  in  which  form  of  insanity 
to  classify  the  subject. 

2.  While  being  examined  as  to  his  general  sensibility 
the  simulator  may  believe  that  anaesthesia  is  a  desir- 
able part  of  the  clinical  picture ;  he  will  wince  when 
probed  with  a  pin  unexpectedly,  but  will  remain  im- 
moble  when  pricked  after  being  warned. 

3.  When  a  simulator  is  accused  of  shamming  he  may 
either  turn  away  from  the  examiner  or  suddenly  lapse 
into  stupor  or  undergo  some  other  unnatural  change  of 
the  symptoms.     A  real  lunatic  will  either  act  as  a  sane 
person  under  those  circumstances,  or,  as  in  apathetic 
states,  show  no  change  whatever. 

4.  A  simulator,  if  transferred  from  one  ward  to  an- 
other of  an  asylum,  will  imitate  the  different  forms  of 
insanity  he  sees  there.     Imitations  may  occur  in  real 
insanity,  but  it  is  limited  to  delusive  conceptions  which 
are  accepted  by  the  weak-minded  lunatics  from  more 
intelligent  ones,  —  in  what  the  French  c&llfolie  commu- 
niqutfe  and  folie  cl  deux. 

Simulation  should  not  be  directly  charged  until  all 
other  means  have  been  exhausted.  Anaesthesia,  by 
the  use  of  ether,  may  sometimes  be  of  value ;  and  the 
application  of  the  Faradic  wire  brush  may  sometimes 
expose  the  simulation.  It  should  be  remembered  in 
this  connection  that  the  insane  sometimes  simulate  a 
different  form  of  insanity  from  that  which  they  ac- 


306  MEDICAL  JURISPRUDENCE. 

tually  have ;  this  combination  of  real  and  feigned  dis- 
ease is  by  no  means  rare.  See  Dr.  Spitzka's  Work,  and 
an  article  upon  the  "Simulation  of  Insanity  by  the 
Insane,"  by  Dr.  Kiernan,  in  the  "Alienist  and  Neuro- 
logist," April,  1882. 

The  legal  effect  of  Insanity  may  come  before  courts 
of  law  for  decision  in  a  variety  of  cases  :  — 

1.  Where  insanity  is  pleaded  as  a  defence  to  an  in- 
dictment for  crime. 

2.  In  civil  causes  where  the  insanity  is  alleged  in 
order  to  supersede  a  person  in  the  management  of  his 
affairs,  or  where  it  is  alleged  for  the  purpose  of  avoiding 
a  contract  or  will. 

3.  In  either  civil  or  criminal  causes  when  it  is  ob- 
jected to  a  witness  that  he  was  insane  at  the  time  of 
the  occurrence  of  the  events  of  which  he  is  to  testify, 
or  that  he  has  had  an  attack  of  insanity  between  those 
events  and  the  trial,  —  which  objection  is  by  Dr.  Ogston 
said  to  be  valid  in  Scottish  practice,  although  it  is  not 
either  in  England  of  in  this  country. 

1.  The  attempts  of  the  courts  to  fix  upon  a  criterion 
by  which  to  settle  legal  responsibility  for  crime  in  cases 
of  alleged  insanity  have  been  numerous,  but  have  not 
thus  far  met  with  success.  By  most  of  the  courts  the 
law  is  still  laid  down  in  accordance  with  the  doctrine 
of  McNaghtcrts  Case,  which  will  be  found  reported  in 
vol.  10  of  Clark  &  Finnelly's  "  Reports  of  Cases  in  the 
House  of  Lords,"  p.  200.  In  this  case  McNaghten  was 
indicted  for  the  murder  of  Drummond  by  shooting  on 
Jan.  20,  1843,  and  the  verdict  was  "  Not  guilty,  on  the 
ground  of  insanity."  This  verdict  and  the  question  of 
the  nature  and  extent  of  the  uusouudness  of  mind 


INSANITY.  3G7 

•which  excuse  the  commission  of  a  felony  of  this  sort 
having  been  made  the  subject  of  debate  in  the  House 
of  Lords,  the  opinion  of  the  judges  on  the  law  govern- 
ing such  cases  was  required  upon  a  series  of  questions  ; 
to  which  they  answered  in  substance  that  the  responsi- 
bility of  a  person  alleged  to  be  insane,  and  who  is  ac- 
cused of  crime,  depends  upon  whether  or  not  the  accused 
at  the  time  had  sufficient  capacity  to  know  the  nature 
and  quality  of  the  act  he  was  doing,  and  whether  what 
he  was  doing  was  right  or  wrong.  As  the  case  is  one 
frequently  referred  to,  we  have  thought  it  proper  to 
state  the  questions  and  answers  thereto  at  length  in  a 
note.1 

1  Tindall,  C.  J.  :  "  The  first  question  proposed  by  your  Lordships  is 
this:  'What  is  the  law  respecting  alleged  crimes  committed  by  per- 
sons afflicted  with  insane  delusion  in  respect  of  one  or  more  particular 
subjects  or  persons  ?  —  as,  for  instance,  where  at  the  time  of  the  com* 
mission  of  the  alleged  crime  the  accused  knew  he  was  acting  contraiy 
to  law,  but  did  the  act  complained  of  with  a  view,'  under  the  influence 
of  insane  delusion,  of  redressing  or  revenging  some  supposed  grievance 
or  injury,  or  of  producing  some  supposed  public  benefit.' 

"  In  answer  to  which  question,  assuming  that  your  Lordships'  in- 
quiries are  confined  to  those  persons  who  labor  under  such  partial 
delusions  only,  and  are  not  in  other  respects  insane,  we  are  of  the  opin- 
ion that,  notwithstanding  the  party  accused  did  the  act  complained  of 
with  a  view,  under  the  influence  of  insane  delusion,  of  redressing  or  re- 
venging some  supposed  grievance  or  injury,  or  of  producing  some  pub- 
lic benefit,  he  is  nevertheless  punishable  according  to  the  nature  of  the 
crime  committed,  if  he  knew  at  the  time  of  committing  such  crime  that 
he  was  acting  contrary  to  law  ;  by  which  expression  we  understand 
your  Lordships  to  mean  the  law  of  the  land. 

"  Your  Lordships  are  pleased  to  inquire  of  us,  secondly,  '  What  are 
the  proper  questions  to  be  submitted  to  the  jury,  where  a  person  al- 
leged to  be  afflicted  with  insane  delusion  respecting  one  or  more  par- 
ticular subjects  or  persons  is  charged  with  the  commission  of  a  crime 
(murder,  for  example),  and  insanity  is  set  up  as  a  defence?'  And 


368  MEDICAL  JURISPRUDENCE. 

The  criterion  laid  down  in  this  case  is,  to  say  the 
least,  very  unsatisfactory.  Although  without  doubt  a 
person  who  is  by  reason  of  mental  disease  unable  to 
comprehend  the  difference  between  right  and  wrong  in 
a  particular  instance  ought  not  to  be  punished  as  for  a 
crime,  the  criterion  under  consideration  is  entirely  of 
too  limited  application,  and  if  strictly  applied  must 
lead  to  the  conviction  and  punishment  of  many  per- 
sons clearly  irresponsible. 

The  limited  space  at  our  disposal  will  not  permit  the 
full  discussion  of  this  important  subject ;  the  reader  is 
accordingly  referred  to  the  very  clear  and  conclusive 
argument  upon  the  subject  by  Dr.  Ray,  in  the  first 

thirdly,  '  In  what  terms  ought  the  question  to  be  left  to  the  jury  as  to 
the  prisoner's  state  of  mind  at  the  time  when  the  act  was  committed  ? ' 
And  as  these  two  questions  appear  to  us  to  be  more  conveniently  an- 
swered together,  we  have  to  submit  our  opinion  to  be  that  the  jurors 
ought  to  be  told  in  all  cases  that  every  man  is  to  be  presumed  to  be 
sane,  and  to  possess  a  sufficient  degree  of  reason  to  be  responsible  for 
his  ciimes,  until  the  contrary  be  proved  to  their  satisfaction;  and  that 
to  establish  a  defence  on  the  ground  of  insanity,  it  must  be  clearly 
proved  that  at  the  time  of  the  committing  of  the  act  the  party  accused 
was  laboring  under  such  a  defect  of  reason,  from  disease  of  the  mind, 
as  not  to  know  the  nature  and  quality  of  the  act  he  was  doing  ;  or  if 
he  did  know  it,  that  he  did  not  know  he  was  doing  what  was  wrong. 
The  mode  of  putting  the  latter  part  of  the  question  to  the  jury  on 
these  occasions  has  generally  been,  whether  the  accused  at  the  time  of 
doing  the  act  knew  the  difference  between  right  and  wrong  ;  which 
mode,  though  rarely,  if  ever,  leading  to  any  mistake  with  the  jury,  is 
not,  as  we  conceive,  so  accurate  when  put  generally  and  in  the  abstract 
as  when  put  with  reference  to  the  party's  knowledge  of  right  and  wrong 
in  respect  to  the  very  act  with  which  he  is  charged.  If  the  question 
were  to  be  put  as  to  the  knowledge  of  the  accused  solely  and  exclusively 
with  reference  to  the  law  of  the  land,  it  might  tend  to  confound  the 
jury,  by  inducing  them  to  believe  that  an  actual  knowledge  of  the  law 
of  the  land  was  essential  in  order  to  lead  to  a  conviction  ;  whereas  the 


INSANITY.  3G9 

chapter  of  his  work  upon  the  Medical  Jurisprudence 
of  Insanity. 

This  doctrine  has  not  always  been  approved  by  legal 
authors  and  courts.  Upon  this  subject  Mr.  Bishop,  in 
his  work  upon  Criminal  Law,  vol.  i.  sect.  381,  says 
that  "  in  the  criminal  law  insanity  is  any  defect,  weak- 
ness, or  disease  of  the  mind  rendering  it  incapable  of 
entertaining  the  criminal  intent,  which  constitutes  one 
of  the  elements  in  every  crime." 

In  the  further  consideration  of  the  subject  he  ob- 
serves that  a  legal  test  for  insanity  has  never  been 
found,  because  it  does  not  exist;  that  the  question 

law  is  administered  upon  the  principle  that  every  one  must  be  taken 
conclusively  to  know  it,  without  proof  that  he  does  know  it.  If  the 
accused  was  conscious  that  the  act  was  one  which  he  ought  not  to  do, 
and  if  that  act  was  at  the  same  time  contrary  to  the  law  of  the  land, 
he  is  punishable  ;  and  the  usual  course  therefore  has  been  to  leave  the 
question  to  the  jury  whether  the  party  accused  had  a  sufficient  degree 
of  reason  to  know  that  he  was  doing  an  act  that  was  wrong  ;  and  this 
course  we  think  is  correct,  accompanied  with  such  observations  and  ex- 
planations as  the  circumstances  of  each  particular  case  may  require. 

' '  The  fourth  question  which  your  Lordships  have  proposed  to  us  is 
this  :  '  If  a  person  under  an  insane  delusion  as  to  existing  facts,  com- 
mits an  offence  in  consequence  thereof,  is  he  thereby  excused  ?'  To 
which  question  the  answer  must,  of  course,  depend  on  the  nature  of  the 
delusion  ;  but  making  the  same  assumption  as  we  did  before,  namely, 
that  he  labors  under  such  partial  delusion  only,  and  is  not  in  other  re- 
spects insane,  we  think  he  must  be  considered  in  the  same  situation  as 
to  responsibility  as  if  the  facts  with  respect  to  which  the  delusion  ex- 
ists were  real.  For  example,  if  under  the  influence  of  his  delusion  he 
supposes  another  man  to  be  in  the  act  of  attempting  to  take  away  his 
life,  and  he  kills  that  man,  as  he  supposes  in  self-defence,  he  would  be 
exempt  from  punishment.  If  his  delusion  was  that  the  deceased  had 
inflicted  a  serious  injury  to  his  character  and  fortune,  and  he  killed 
him  in  revenge  for  such  supposed  injury,  he  would  be  liable  to 
punishment." 

24 


370  MEDICAL  JURISPRUDENCE. 

whether  in  a  particular  instance  the  act  alleged  to  be 
a  crime  proceeded  from  a  sane  or  insane  mind,  is  a  pure 
question  of  fact  for  the  jury,  and  not  of  law  for  the  court ; 
as,  for  example,  it  is  a  question  of  fact  for  the  jury,  and 
not  of  law  for  the  court,  whether  there  is  such  a  disease 
as  dipsomania,  and  whether  the  act  in  question  was  occa- 
sioned by  this  disease,  or  was  the  act  of  a  sound  mind.1 

This  seems  a  much  more  rational  method  of  proced- 
ure than  to  attempt  to  define  any  rigid  test.  Where 
each  case  is  determined  upon  its  own  circumstances  by 
the  evidence  of  competent  experts  before  a  jury,  in  the 
same  manner  as  other  disputed  questions  of  fact  are  de- 
termined, there  will  be  comparatively  little  danger  of 
going  astray,  although  it  is  possible  that  there  might  be 
improvements  in  the  method  of  securing  the  opinion  of 
such  experts. 

For  the  further  consideration  of  this  subject  the 
reader  is  referred  to  the  preliminary  chapter  of  Ray's 
"  Medical  Jurisprudence,"  and  to  chap.  26,  vol.  i. 
Bishop's  "  Criminal  Law." 

2.  The  procedure  upon  inquiries  as  to  the  idiocy  or 
lunacy  of  any  person  having  estate,  real  or  personal, 
which  is  likely  to  be  dissipated  so  as  to  expose  himself 
or  family  to  want  or  suffering,  is  regulated  by  statute 
in  most  of  the  States,  to  which  statutes  the  student  is 
referred.  The  question  in  such  cases  as  to  the  inability 
of  a  person  to  manage  his  affairs,  on  the  ground  of  in- 
sanity and  consequent  incapacity,  is  one  of  fact  to  be 

1  See  1  Bishop  Crim.  law,  §  383;  The  State  vs.  Pike,  49  N.  H. 
399  ;  Bradley  vs.  The  State,  31  Ind.  492  ;  The  State  vs.  Jones,  50 
N.  H.  369  ;  The  State  vs.  Johnson,  40  Conn.  136;  Stevens  vs.  The 
State,  31  Ind.  485  ;  4  Law  Review,  236. 


INSANITY.  371 

determined  by  the  circumstances  of  each  particular  case. 
The  principles  hereinafter  stated  will  throw  some  light 
upon  the  question  of  capacity  in  such  cases. 

If  physicians  who  have  certified  to  the  insanity  of 
a  person  have  not  made  the  inquiry  and  examination 
which  the  statute  requires,  or  if  their  evidence  and 
certificate  in  any  respect  of  form  or  substance  are  not 
sufficient  to  justify  a  commitment  to  an  asylum,  the 
authorities  should  not  commit ;  and  if  they  do,  it  is 
not  the  fault  of  the  physicians,  provided  the  latter  have 
stated  facts  and  opinions  truly,  and  have  acted  with  due 
professional  care  and  skill. 

If  a  medical  man  takes  upon  himself  the  responsi- 
bility of  imprisoning  a  person  on  the  ground  of  insanity 
on  mere  statements  made  to  him  by  others,  he  will  be 
liable  to  an  action  unless  he  can  show  that  the  party 
imprisoned  was  insane  at  the  time.  A  medical  man  or 
any  other  person  may,  however,  justify  an  assault  where 
it  is  committed  for  the  purpose  of  putting  restraint  on 
a  dangerous  lunatic  in  such  a  state  that  he  is  likely  to 
do  mischief  to  some  one ;  this  restraint,  however,  can- 
not be  continued  indefinitely  without  due  process  of 
law,  but  only  so  far  as  may  be  necessary  to  prevent 
damage  and  to  have  his  case  properly  passed  upon  by 
legally  constituted  authorities. 

It  is  •well  settled  that  insanity  may  be  pleaded  by  an 
insane  person  in  avoidance  of  his  contracts  made  while 
insane.  The  degree  of  unsoundness  of  mind  required 
to  incapacitate  a  person  from  contracting  may  be  stated 
to  be  such  a  condition  of  insanity  or  idiocy  as  from  its 
character  or  intensity  disables  him  from  understanding 
the  nature  and  effects  of  his  acts,  and  therefore  dis- 


372  MEDICAL  JURISPRUDENCE. 

qualifies  him  for  transacting  business  and  managing 
his  property.  It  is  well  settled  that  in  the  absence  of 
fraud,  imposition,  or  undue  influence,  mere  weakness 
or  feebleness  of  understanding  short  of  this  is  insuf- 
ficient. 

One  who  seeks  to  set  aside  a  contract  upon  the 
ground  of  insanity  alone,  general  or  partial,  must  show 
that  it  was  the  offspring  of  mental  disease.  Thus  mono- 
mania, in  no  way  connected  with  the  subject  of  the 
contract,  will  not  invalidate  it.  The  unsoundness  of 
mind  required  to  vitiate  a  contract  must  also  exist  at 
the  time  of  making  such  contract. 

The  contract  of  a  person  non  compos  mentis  is  void- 
able only,  and  not  void ;  and  hence  on  his  restoration  to 
reason  may  be  ratified  or  avoided  by  him.  After  a  ju- 
dicial finding  of  the  fact  of  insanity,  however,  the  deeds 
and  other  contracts  of  persons  non  compos  mentis  are 
held  to  be  void  ;  though  in  some  cases  this  seems  to  be 
the  result  of  statutory  provisions.  The  marriage  of  a 
person  non  compos  mentis  is,  according  to  the  better 
opinion,  void. 

As  to  the  executed  contracts  of  insane  persons,  the  case 
of  Motion  vs.  Camroux,  2  Exchequer  Eeports,  487  ;  s.  c. 
4  id.  17  ;  Swell's  Leading  Cases,  614,  lays  down  the  rule 
that  where  a  person  apparently  of  sound  mind,  and  not 
known  to  be  otherwise,  enters  into  a  contract  which  is 
fair  and  lona  fide,  and  which  is  executed  and  completed, 
and  the  property  the  subject  matter  of  the  contract  can- 
not be  restored  so  as  to  put  the  parties  in  statu  quo,  such 
contract  cannot  afterwards  be  set  aside  either  by  the  al- 
leged lunatic  or  by  those  who  represent  him.  The  rule 
of  this  case  has  been  adopted  in  New  Hampshire,  Iowa, 


INSANITY.  373 

New  York,  Pennsylvania,  New  Jersey,  South  Carolina, 
Indiana,  and  perhaps  other  States  ;  and  on  principles  of 
public  policy  must  ultimately  prevail  everywhere. 

Although  a  lunatic  has  not  a  general  capacity  to 
enter  into  contracts,  it  is  well  settled  that  he  may  bind 
himself  by  implied  contracts  for  necessaries  suitable  to 
his  condition  in  life.  It  is  well  settled,  also,  that  idiocy 
or  lunacy  is  no  defence  to  an  action  for  a  tort,  that  is,  a 
wrong  not  connected  with  contract. 

A  contract  entered  into  by  a  lunatic  during  a  lucid 
interval  will  also  bind  him.  By  the  term  "  lucid  inter- 
val "  is  to  be  understood  a  condition  in  which  there  is  a 
cessation  of  the  symptoms  of  mental  aberration,  and  a 
restoration  to  reason  occurring  between  two  paroxysms 
of  insanity ;  such  a  total  cessation  of  the  symptoms  of 
mental  aberration  and  such  a  complete  restoration  to 
reason,  according  to  Dr.  Hammond,  probably  does  not 
exist  except  in  recurrent  and  epileptic  forms  of  in- 
sanity, and  in  certain  varieties  of  monomania,  and  of 
morbid  impulse.  He  well  states  that  the  idea  of  a 
lucid  interval  being  a  temporary  cure  is  now  confined 
to  the  writings  of  those  whose  notions  of  the  disease 
have  been  derived  from  books  rather  than  the  wards 
of  hospitals.  Like  most  other  diseases,  insanity  is  sub- 
ject to  remissions  more  or  less  complete,  and  there  is 
no  more  propriety  in  regarding  them  as  recoveries  than 
there  would  be  in  considering  the  interval  between  the 
paroxysms  of  a  quotidian  fever  as  a  temporary  recovery. 

General  insanity  being  established,  the  burden  of 
proof  is  thrown  upon  the  party  alleging  a  lucid  inter- 
val, who  must  establish,  beyond  a  mere  cessation  of  the 
violent  symptoms,  a  restoration  of  mind  sufficient  to 


374  MEDICAL  JURISPRUDENCE. 

enable  the  party  soundly  to  judge  of  the  act.  Where 
a  disease  ultimately  affecting  the  mind  is  insidious  and 
slow  in  its  development,  and  there  is  ground  for  sus- 
picion that  previous  to  the  factum,  apprehensions  were 
entertained  of  the  possible  approach  of  mental  de- 
rangement, there  should  be  a  careful  scrutiny  of  an  act 
performed  shortly  before  an  accession  of  undoubted 
symptoms,  in  order  to  see  whether  it  was  a  rational 
and  natural  act  comformable  with  the  views  and  wishes 
of  the  party  when  in  a  state  of  health. 

Contracts  or  other  legal  instruments  executed  in  al- 
leged lucid  intervals  should  therefore  be  closely  scruti- 
nized and  looked  upon  with  some  degree  of  suspicion ; 
but  where  capacity  to  contract  is  clearly  shown  to  exist, 
the  contract  or  other  act  must  be  sustained. 

As  to  the  degree  of  mental  capacity  requisite  to  make 
a  valid  will,  Judge  Redfield  states  that  a  lower  degree 
of  intellect  is  requisite  to  make  a  valid  will  than  to 
make  a  valid  contract ;  but  in  the  former  case  something 
more  is  required  than  mere  passive  memory.  There 
must  be  sufficient  active  memory  to  collect  and  retain 
the  elements  of  the  business  to  be  performed  for  a  suffi- 
cient time  to  perceive  their  obvious  relations  to  each 
other.  The  testator  must  have  a  sound  mind  and  dis- 
posing memory ;  in  other  words,  he  ought  to  be  capable 
of  making  his  will  with  an  understanding  of  the  nature 
of  the  business  in  which  he  is  engaged,  the  elements  of 
which  the  will  is  composed,  .and  a  recollection  of  the 
property  of  which  he  means  to  dispose,  of  the  persons 
who  are  the  objects  of  his  bounty,  and  the  manner  in 
which  it  is  to  be  distributed  among  them. 

A  morbid  delusion  is  good  in  defeasance  of  a  will 


INSANITY.  375 

founded  immediately  in  or  upon  such  delusion.  This 
was  settled  by  the  celebrated  case  of  Dew  vs.  Clarke, 
decided  by  Sir  John  Nichol  in  the  Prerogative  Court 
of  Canterbury  in  1826.  In  this  case  Sir  John  Nichol 
stated  his  opinion  that  the  true  criterion  of  the  absence 
or  presence  of  insanity  is  the  absence  or  presence  of 
delusion.  This,  however,  cannot  at  the  present  time 
be  regarded  as  the  law.  If  a  delusion  exists  it  is,  of 
course,  clearly  evidence  of  insanity ;  but  its  absence  is, 
as  we  have  already  seen,  by  no  means  proof  or  even 
evidence  of  a  sane  condition. 

Deaf  and  Dumb  Persona.  —  Deaf  and  dumb  persons, 
although  formerly  in  presumption  of  law  idiots,  are  no 
longer  so  considered ;  and  it  may  perhaps  now  be  said 
that  there  is  in  the  United  States  at  least,  as  to  them 
no  presumption  of  a  defective  understanding.  In  order, 
however,  to  ensure  protection  and  prevent  fraud,  proof 
would  probably  be  required  that  such  a  person  was 
capable  of  comprehending  what  he  was  about  in  exe- 
cuting any  instrument. 

Where  a  person  presented  as  a  witness  is  of  unsound 
mind  to  such  an  extent  as  to  be  incapable  of  compre- 
hending the  nature  and  obligation  of  an  oath,  or  the 
nature  and  relations  of  the  subject  matter  about  which 
he  is  to  testify,  it  is  very  clear  that  he  is  not  a  com- 
petent witness.  A  person  to  some  extent  insane  but 
not  wholly  devoid  of  reason,  may,  however,  be  permitted 
to  testify  if  the  court  is  satisfied  that  he  possesses  suffi- 
cient capacity  to  comprehend  the  facts,  to  understand 
the  nature  of  an  oath,  and  to  communicate  his  testi- 
mony. Where  such  testimony  has  been  received,  evi- 
dence that  the  witness  has  been  of  unsound  mind  and 


376  MEDICAL  JURISPRUDENCE. 

memory  is  admissible  to  affect  the  credibility  of  his 
testimony ;  whether  he  has  sufficient  understanding 
must  be  decided  by  the  court  upon  examination  of  the 
proposed  witness  himself  and  other  witnesses  who  can 
speak  as  to  the  nature  and  extent  of  the  insanity  in 
question.  Where  the  witness  at  the  time  of  the  trial 
is  of  sound  mind  and  memory,  but  the  evidence  shows 
that  his  intellect  was  to  a  greater  or  less  degree  im- 
paired at  the  time  of  the  transaction  as  to  which  he 
testifies,  he  is  a  competent  witness,  but  the  question  of 
his  credibility  is  for  the  jury. 

See  this  whole  subject  considered  at  length  in  16 
"  Western  Jurist,"  122. 

Somnambulism.  —  As  to  the  legal  responsibility  of 
persons  accused  of  crime  alleged  to  have  been  com- 
mitted in  the  somnambulistic  state,  or  in  that  state  of 
mental  confusion  sometimes  met  with  between  sleeping 
and  waking,  the  difficulty,  as  it  seems  to  us,  is  prin- 
cipally one  of  proof.  If  it  can  be  established  to  the 
satisfaction  of  the  jury  that  the  accused  did  not  enjoy 
the  free  and  rational  exercise,  of  his  understanding,  and 
was  unconscious  of  his  outward  relations  at  the  time  of 
the  commission  of  the  alleged  crime,  there  would  seem 
to  be  no  doubt  that  he  is  not  criminally  responsible. 

Induced  Hypnotism.  —  The  subject  of  induced  hyp- 
notism is  undergoing  investigation  both  in  France  and 
in  this  country,  and  important  questions  as  to  criminal 
responsibility  may  arise  therefrom.  At  present,  how- 
ever, in  advance  of  any  adjudicated  cases  upon  the  sub- 
ject, its  consideration  here  would  be  premature. 

Drunkenness.  —  Voluntary  drunkenness  is  no  defence 
to  a  criminal  charge.  Where,  however,  a  permanent 


INSANITY.  377 

condition  of  insanity  has  resulted  from  the  habit  of 
drunkenness,  the  same  rule  should  be  applied  as  in  the 
case  of  insanity  due  to  other  causes.  As  to  contracts, 
it  is  well  settled  that  a  contract  entered  into  by  a  per- 
son when  in  such  a  state  of  intoxication  as  to  deprive 
him  of  the  exercise  of  his  understanding  is  voidable, 
although  the  intoxication  was  voluntary  and  not  pro- 
cured through  the  circumvention  of  the  other  party. 

A  last  will  and  testament  made  by  a  person  while 
so  intoxicated  as  not  to  understand  the  nature  or  effect 
thereof  will  not  be  allowed  to  stand. 


CHAPTER  XXII. 

SOME    RULES     OF    THE     COMMON     LAW    RESPECTING    THE 
DISPOSITION   OF   HUMAN   DEAD   BODIES. 

LEGISLATION  UPON  THE  SUBJECT  OF  ANATOMY,  AND  A  DRAUGHT 
OP  AN  ACT  TO  PROMOTE  THE  SCIENCE  OF  ANATOMY, 
MEDICINE,  AND  SURGERY. 

So  far  as  the  writer  has  been  able  to  discover,  there 
seems  in  all  ages  to  have  been,  in  the  non-professional 
mind  at  least,  a  peculiar  aversion  towards  and  horror  of 
dead  bodies  of  human  beings.  The  laws  of  Menu,  en- 
acted, according  to  Sir  William  Jones,  from  880  to  1,280 
years  before  Christ  ("  Sir  William  Jones's  Works,"  pp. 
79,  80),  contain  many  provisions  respecting  uncleanuess 
and  purification  therefrom,  by  reason  of  the  dead,  and  it 
seems  everywhere  assumed  that  dead  bodies  are  unclean. 
Thus,  among  many  other  provisions,  we  find  the  follow- 
ing :  "  He  who  has  touched  a  chandala,  a  woman  in 
her  courses,  an  outcast  for  deadly  sin,  a  new-born  child, 
a  corpse,  or  one  who  has  touched  a  corpse,  is  made  pure 
by  bathing."  —  Laws  of  Menu,  ch.  5,  §  85. 

"  Should  a  Brahmin  touch  a  human  bone  moist  with 
oil,  he  is  purified  by  bathing ;  if  it  be  not  oily,  by  strok- 
ing a  cow,  or  by  looking  at  the  sun,  having  sprinkled 
his  mouth  with  water."  —  Ib.  §  87. 

The  Koran  likewise  denounced  as  unclean  the  person 
who  touched  a  corpse,  and  the  rules  of  Islamism  still 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        379 

forbid  dissection.  Likewise  by  the  laws  of  the  Franks, 
a  person  who  dug  a  corpse  out  of  the  ground  in  order 
to  strip  it  was  banished  from  society,  and  no  one  suf- 
fered to  relieve  his  wants  till  the  relations  of  the  de- 
ceased consented  to  his  readmission.  —  4  Black.  Cora., 
235 ;  Montesq.  Spir.  Laws,  b.  xxx.  c.  19. 

By  the  common  law  of  England  —  and  the  rule  of 
the  American  common  law  is  believed  to  be  the  same 
—  it  is  an  indictable  offence  to  take  up  a  dead 
body,  even  for  the  purpose  of  dissection,  as  being 
"  contra  bonos  mores,  at  the  bare  idea  alone  of  which," 
say  the  court  in  Rex  vs.  Lynn,  2  Term,  E.  733,  "  nature 
revolted." 

It  is  said  that  a  surgeon  may  retain  the  limbs  he 
amputates  from  a  patient,  upon  the  ground  that  parts 
of  the  body  when  severed  become  dead,  and  at  common 
law  there  is  no  property  in  a  dead  body. 

While  it  is  true  that  at  the  common  law  there  can 
be  no  property  in  a  corpse  (see  Williams  vs.  Williams, 
English  High  Court  of  Justice,  Chancery  Division,  re- 
ported in  21  Am.  Law  Eeg.  [N.  S.],  August,  1882, 
p.  508,  in  the  note  to  which  the  cases  upon  the  subject 
are  quite  fully  collected  by  the  writer),  and  therefore 
stealing  it  is  no  felony,  yet  it  is  a  very  high  misde- 
meanor at  the  common  law,  and  at  the  present  time 
"  body-snatching,"  so-called,  is  made  a  statutory  crime 
in  probably  every  State  of  this  Union. 

In  the  case  of  Dr.  Handyside,  where  trover  was 
brought  against  him  for  the  bodies  of  two  children  that 
grew  together,  Lord  Chief  Justice  Willes  held  that  the 
action  would  not  lie,  as  no  person  had  any  property  in 
corpses. 


380  MEDICAL  JURISPRUDENCE. 

The  case  of  Williams  vs.  Williams  above  cited,  which 
referred  to  the  subject  of  cremation,  and  in  which  it 
was  held  that  a  man  cannot  dispose  of  his  body  by 
will,  that  it  is  the  executor's  duty  to  bury  it,  and  that 
meantime  he  has  the  right  to  possession  of  it,  is  an 
interesting  case  in  this  connection. 

If,  however,  the  coffin  or  any  of  the  grave-clothes 
be  stolen  with  the  body,  it  was  a  felony  at  common 
law. 

By  the  common  law  it  is  an  offence  against  decency 
to  take  a  person's  dead  body  with  intent  to  sell  or  dis- 
pose •  of  it  for  gain  or  profit.  Even  to  sell  the  dead 
body  of  a  capital  convict  for  the  purposes  of  dissection, 
where  dissection  is  no  part  of  the  sentence,  is  a  mis- 
demeanor and  indictable  at  common  law. 

Even  the  refusal  or  neglect  to  bury  dead  bodies  by 
those  whose  duty  it  is  to  perform  the  office  appears 
also  to  have  been  considered  a  misdemeanor.  So  the 
prevention  of  the  interment  of  a  dead  body  has  been 
considered  indictable.  To  cast  a  dead  body  into  a 
river  has  been  held  indictable  at  common  law  as  an 
offence  against  common  decency. 

A  gaoler  has  no  right  to  detain  the  body  of  a  person 
who  has  died  in  prison  for  any  debts  due  to  himself, 
and  is  indictable  for  so  doing. 

It  seems  that  in  a  proper  case  the  court,  in  the  in- 
terest of  justice,  will  order  the  disinterment  and  exam- 
ination of  a  dead  body,  where  there  is  good  reason  to 
believe  that  without  such  examination  a  fraud  will  be 
perpetrated,  and  where  the  defendant  has  exhausted  all 
other  legal  methods  of  exposing  it.  One  such  case  has 
recently  come  to  the  notice  of  the  writer  in  the  city  of 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        381 

Chicago,  where  the  exhumation  furnished  conclusive  evi- 
dence of  an  attempt  to  defraud  an  insurance  company. 

The  dissection  of  human  bodies  being  necessary  for 
the  advancement  of  anatomical  and  medical  science, 
statutory  enactments  were  made  upon  the  subject  in 
England  at  an  early  date,  and  also  exist  in  many  of  the 
States  in  this  country.  The  statutes  of  every  State  and 
Territory  of  this  country  have  been  examined  with 
reference  to  this  subject,  and  it  was  the  writer's  in- 
tention to  have  incorporated  a  digest  of  the  same  in 
this  chapter,  but  it  has  been  found  that  such  a  digest 
would  consume  more  space  than  the  merits  of  many  of 
these  statutes  deserve,  and  it  has  been  thought  better 
to  give  the  English  legislation  upon  the  subject,  and  at 
the  close  to  submit  a  draught  of  an  act  containing  the 
best  features  of  them  all 

The  first  English  statute  upon  the  subject  of  anatomy 
and  dissection  that  we  have  been  able  to  find  is  section 
2  of  chapter  42  of  32  Henry  VIIL,  enacted  in  1540, 
and  entitled,  "  For  Barbers  and  Surgeons."  The  second 
section  of  this  act  is  as  follows :  — 

"And  further  be  it  enacted  by  tbe  authority  afore- 
said, that  the  said  masters  or  governors  of  the  mystery 
and  commonalty  of  barbers  and  surgeons  of  London, 
and  their  successors  yearly  forever,  after  their  said  dis- 
cretions, at  their  free  liberty  and  pleasure,  shall,  and 
may  have,  and  take  without  contradiction,  four  persons 
condemned,  adjudged,  and  put  to  death  for  felony,  by 
the  due  order  of  the  King's  laws  of  this  realm,  for  an- 
atomies, without  further  suit  or  labor  to  be  made  to 
the  King's  highness,  his  heirs  or  successors,  (2)  and  to 
make  incision  of  the  same  dead  bodies,  or  otherwise 


382  MEDICAL  JURISPRUDENCE. 

to  order  the  same  after  their  said  discretions  at  their 
pleasures,  for  their  further  and  better  knowledge,  in- 
struction, insight,  learning,  and  experience  in  the  said 
science  or  faculty  of  surgery."  A  similar  grant  was 
made  by  Elizabeth  in  1565  to  the  College  of  Physicians. 
By  the  statute  25  Geo.  II.,  c.  37,  1752,  entitled  "  An 
Act  for  better  preventing  the  horrid  crime  of  murder " 
(repealed  by  9  Geo.  IV.,  c.  31,  §  1,  1828,  for  consoli- 
dating and  amending  the  statutes  in  England  relative 
to  offences  against  the  person ;  re-enacted  in  substance 
in  sections  4  and  5  of  the  same  statute,  but  repealed  in 
1838  by  section  16  of  2  and  3  Win.  IV.,  ch.  75,  which 
section  16  was  itself  repealed  by  24  and  25  Viet.,  ch.  95, 
§  1),  it  was  enacted,  after  providing  (sect.  1)  that  mur- 
derers should  be  executed  the  next  day  but  one  after  sen- 
tence passed,  that  (sect.  2)  "  the  body  of  such  murderer 
so  convicted  shall,  if  such  conviction  and  execution 
shall  be  in  the  county  of  Middlesex,  or  within  the  city 
of  London  or  the  liberties  thereof,  be  immediately  con- 
veyed by  the  sheriff  or  sheriffs,  Ms  or  their  deputy  or 
deputies,  and  his  or  their  officers,  to  the  hall  of  the  sur- 
geons' company,  or  such  other  place  as  the  said  com- 
pany shall  appoint  for  this  purpose,  and  be  delivered 
to  such  person  as  the  said  company  shall  appoint  for 
this  purpose,  and  be  delivered  to  such  person  as  the 
said  company  shall  depute  or  appoint,  who  shall  give 
to  the  sheriff  or  sheriffs,  his  or  their  deputy  or  deputies, 
receipt  for  the  same ;  and  the  body  so  delivered  to  the 
said  company  of  surgeons  shall  be  dissected  and  anat- 
omized by  the  said  surgeons  or  such  person  as  they 
shall  appoint  for  that  purpose;  and  in  case  said  convic- 
tion and  execution  shall  happen  to  be  in  any  other 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        383 

county  or  place  in  Great  Britain,  then  the  judge  or 
justice  of  assize,  or  other  proper  judge,  shall  award  the 
sentence  to  be  put  in  execution  the  next  day  but  one 
after  such  conviction  (except  as  before  excepted),  and 
the  body  of  such  murderer  shall  in  like  manner  be  de- 
livered by  the  sheriff  or  his  deputy,  and  his  officers,  to 
such  surgeon  as  such  judge  or  justice  shall  direct  for 
the  purpose  aforesaid." 

That  the  purpose  of  this  act  was  less  to  advance  the 
interests  of  science  than  to  terrify  wrong-doers  is  evi- 
dent from  section  3,  which  directs  sentence  to  be  pro- 
nounced immediately,  stating  the  time  of  execution  and 
the  marks  of  infamy  above  specified,  "  in  order  to  im- 
press a  just  horror  in  the  mind  of  the  offender,  and  on 
the  minds  of  such  as  shall  be  present,  of  the  heinous 
crime  of  murder." 

The  statute  above  quoted  has  furnished  a  model, 
which,  with  more  or  less  modifications,  has  been  fol- 
lowed by  several  of  the  States  of  this  Union,  and  among 
others,  by  the  State  of  Illinois, — sect.  443  of  whose 
criminal  code  provides  that  "  the  court  may  order, 
on  the  application  of  any  respectable  surgeon  or  sur- 
geons, that  the  body  of  the  convict  shall  after  death  be 
delivered  to  such  surgeon  or  surgeons  for  dissection, 
unless  the  same  be  objected  to  by  some  relative  of  the 
convict." 1 

In  1832,  the  elaborate  act  of  2  and  3  Wm.  IV., 
ch.  75,  entitled,  "An  Act  for  Regulating  Schools  of 
Anatomy,"  was  passed,  the  preamble  of  which  is  as 
follows :  — 

1  See,  however,  the  provisions  of  the  act  of  1885  ;  ch.  91,  R.  S. 
111.  1885. 


384  MEDICAL  JURISPRUDENCE. 

"  Whereas,  a  knowledge  of  the  causes  and  nature  of 
sundry  diseases  which  affect  the  body,  and  of  the  best 
methods  of  treating  and  curing  such  diseases,  and  of  heal- 
ing and  repairing  divers  wounds  and  injuries  to  which 
the  human  frame  is  liable,  cannot  be  acquired  without 
the  aid  of  anatomical  examination ;  and  whereas,  the 
legal  supply  of  human  bodies  for  such  anatomical  ex- 
amination is  insufficient  fully  to  provide  the  means 
of  such  knowledge ;  and  whereas,  in  order  further  to 
supply  human  bodies  for  such  purposes  divers  great 
and  grievous  crimes  have  been  committed,  and  lately 
murder,  for  the  single  object  of  selling  for  such  pur- 
poses the  bodies  of  the  persons  so  murdered;  and 
whereas,  therefore,  it  is  highly  expedient  to  give  pro- 
tection, under  certain  regulations,  to  the  study  and 
practice  of  anatomy,  and  to  prevent,  so  far  as  may  be, 
such  great  and  grievous  crimes  and  murder  as  afore- 
said, be  it  enacted,"  etc. 

The  act  then  proceeds  to  provide  (sect.  1)  for  licenses 
to  practise  anatomy;  (sect.  2)  for  the  appointment  of 
inspectors  of  schools  of  anatomy ;  (sect.  3)  the  districts 
they  shall  superintend ;  (sect.  4)  for  returns  by  the  in- 
spectors of  subjects  removed  for  anatomical  examina- 
tion ;  (sect.  5)  for  the  inspection  of  places  where  anatomy 
is  practised ;  (sect.  6)  for  salaries  of  inspectors. 

SECT.  7  makes  it  lawful  for  any  executor  or  other 
person  having  lawful  possession  of  the  body  of  any  de- 
ceased person,  and  not  being  an  undertaker  or  other 
party  entrusted  with  the  body  for  the  sole  purpose  of 
interment,  to  permit  such  dead  body  to  undergo  ana- 
tomical examination,  unless,  to  the  knowledge  of  such 
executor  or  other  person  such  person  during  his  life 


DISPOSITION  OF  HUMAN  DEAD   BODIES.        385 

expressed  a  desire  that  his  body  should  not  undergo 
such  examination,  or  unless  the  surviving  husband  or 
wife,  or  any  known  relative  of  the  deceased,  shall  re- 
quire the  body  to  be  interred  without  such  examination. 

SECT.  8  requires  the  party  having  lawful  possession 
of  the  dead  body  of  any  deceased  person  who  has,  dur- 
ing his  life,  directed  the  anatomical  examination  of  his 
body,  to  direct  such  examination  to  be  made,  unless  the 
deceased  person's  surviving  husband  or  wife,  or  nearest 
known  relative,  shall  require  the  body  to  be  interred 
without  such  examination. 

SECT.  9  prohibits  the  removal  for  anatomical  exami- 
nation of  the  body  of  any  person  from  the  place  where 
such  person  died,  within  a  certain  time,  and  without  a 
certificate  of  the  manner  of  death. 

SECT.  10  makes  it  lawful  for  professors,  surgeons, 
etc.,  being  licensed  as  aforesaid,  to  receive  bodies  for  an- 
atomical examination  under  the  provisions  of  the  act. 

SECT.  11  provides  that  the  persons  mentioned  in  the 
last  section  shall  receive  with  the  body  a  certificate  as 
aforesaid,  which  shall  be  transmitted  to  the  inspector 
of  the  district,  with  a  return  stating  from  whom  received, 
date  and  place  of  death,  sex,  name,  etc.,  and  that  the 
said  certificate  and  particulars  shall  be  by  such  license 
recorded  in  a  book  kept  by  him  for  that  purpose,  etc. 

SECT.  12  requires  notice  to  be  given  to  the  Secre- 
tary of  State  of  places  where  anatomy  is  about  to  be 
practised. 

SECT.  13  regulates  the  manner  of  removing  bodies  for 
examination,  provides  for  their  interment  after  exami- 
nation, and  for  the  transmission  of  a  certificate  of  in- 
terment to  the  inspector  of  the  district. 

25 


386  MEDICAL  JURISPRUDENCE. 

SECT.  14  provides  that  the  persons  licensed  under  the 
act  shall  not  be  liable  to  punishment  for  having  in  their 
possession  or  examining  dead  bodies  according  to  the 
provisions  of  the  act. 

SECT.  15  provides  that  nothing  in  the  act  contained 
shall  be  construed  to  extend  to  or  prohibit  any  post- 
mortem examination  of  any  human  dead  body  required 
or  directed  to  be  made  by  any  competent  legal  authority. 

SECT.  16  repeals  so  much  of  9  Geo.  IV.,  ch.  31,  as 
directs  that  the  bodies  of  murderers  may  be  dissected 
or  hung  in  chains  as  ordered  by  the  court ;  and  enacts 
that  such  bodies  shall  be  hung  in  chains  or  buried,  as 
the  court  shall  direct.  (This  sect.  16  was  repealed  by 
24  and  25  Viet,  c.  95,  §  1). 

SECT.  17  limits  the  time  within  which  actions  for 
anything  done  under  the  act  shall  be  brought,  and 
regulates  the  pleading  therein. 

SECT.  18  prescribes  the  punishment  for  offences 
against  the  act. 

SECT.  19  defines  the  interpretation  of  certain  words 
in  the  act. 

SECT.  20  provides  that  the  act  shall  go  into  effect 
August  1,  1832. 

SECT.  21  provides  that  the  act  may  be  altered  or 
amended  during  the  current  session  of  Parliament. 

In  1871  (34  Viet.,  ch.  16,  §  2)  the  Secretary  of  State 
and  the  chief  Secretary  of  Ireland  were  empowered 
from  time  to  time  to  vary  the  period  limited  by  sect. 
13  of  2  and  3  Wm.  IV.,  ch.  75,  for  transmission  of  cer- 
tificates of  interment  to  district  inspectors. 

This  appears  to  be  the  latest  legislation  upon  the 
subject  in  England. 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        387 

In  this  country  there  is  quite  a  diversity  among  the 
statutes  upon  this  subject,  and  in  many  of  the  States, 
especially  the  Southern  States,  there  is  no  legislation 
whatever  upon  the  subject,  other  than  statutes  prohibit- 
ing the  robbing  of  graves,  etc.  Many  statutes  provide 
that  "  it  shall  be  lawful "  for  the  designated  officers  to 
deliver  up  the  dead  bodies,  etc.,  or  that  they  "may" 
deliver,  etc.,  without  containing  words  making  it  the 
imperative  duty  of  such  officers  to  deliver,  etc.  It  is 
very  possible,  and  in  some  cases  probable,  that  the  word 
"  may "  in  such  statutes  should  be  construed  to  mean 
"  shall "  or  "  must."  "  The  words  ' may '  or  'shall,'  when 
used  in  a  statute,  may  be  read  interchangeably,  as  will 
best  express  the  legislative  intention.  The  rule  is  that 
{ the  word  may  means  must  or  shall  only  in  cases  where 
public  interests  and  rights  are  concerned,  and  the  pub- 
lic or  third  persons  have  a  claim  dejure  that  the  power 
shall  be  exercised.'  "  Where  a  statute  directs  the  doing 
of  a  thing  for  the  sake  of  justice  or  the  public  good,  the 
word  "  may  "  is  the  same  as  the  word  "  shall."  Thus, 
•where  a  statute  says  that  a  sheriff  may  take  bail,  it  has 
been  construed  to  mean  that  he  shall  do  so. 

On  the  other  hand,  if  any  right  to  any  one  depends 
upon  giving  to  the  word  "shall"  an  imperative  con- 
struction, the  presumption  is  that  the  word  was  used 
in  reference  to  such  right  or  benefit;  but  where  no 
right  or  benefit  to  any  one  depends  upon  the  impera- 
tive use  of  the  word,  it  may  be  held  to  be  directory 
merely. 

In  the  draught  of  a  statute  upon  this  subject,  therefore, 
it  is  better,  in  order  to  avoid  doubt,  to  use  such  words  as 
express  unequivocally  the  intention  of  the  legislature  to 


388  MEDICAL  JURISPRUDENCE. 

impose  upon  the  officials  mentioned  in  the  act  a  duty 
to  deliver,  etc. 

Many  statutes  contain  a  provision  authorizing  the 
delivery  of  dead  bodies  to  county  medical  associations, 
or  to  some  reputable  physician  in  cases  where  there  is 
no  medical  school  in  the  county.  Such  a  provision,  as 
well  as  others  that  might  be  mentioned,  are  doubtless 
desirable  in  some  cases,  but  they  have  not  been  included 
in  this  draught.  If  thought  desirable,  it  will  be  easy  to 
incorporate  such  provisions.  It  is  believed  that  all  the 
really  good  features  of  the  various  acts  upon  this  subject, 
which  are  to  be  found  upon  the  statute-books  of  the 
various  States  of  this  Union,  will  be  found  in  this  bill, 
and  a  number  of  other  provisions  which  seemed  neces- 
sary have  also  been  incorporated  in  it.  It  is  inserted 
in  this  place  simply  as  a  precedent,  in  the  hope  that  it 
may  be  of  assistance  to  some  one  called  upon  to  draught 
such  an  act. 

An  Act  to  promote  the  science  of  anatomy,  medicine, 
and  surgery. 

Be  it  enacted,  etc. :  — 

SECTION  1.  The  right  to  dissect  the  dead  body  of  a 
human  being  or  any  part  thereof  shall  exist  in  the  fol- 
lowing cases : 

(1)  In  cases  authorized  by  positive  enactment  of  the 
General  Assembly   of  this   State,   in    this   and   other 
statutes. 

(2)  Whenever  a  coroner  is  authorized  by  law  to  hold 
an  inquest  upon  the  body,  so  far  as  such  coroner  author- 
izes dissection  for  the  purposes  of  the  inquest  and  no 
farther. 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        389 

(3)  Whenever  and  so  far  as  the   husband,  wife,  or 
next  of  kin  of  the  deceased,  in  case  the  deceased  leaves 
no  surviving  husband  or  wife,  may  authorize  dissection 
for  the  purpose  of  ascertaining  the  cause  of  death,  and 
no  farther. 

(4)  Whenever  a   person    has,   during   his   lifetime 
directed  that  his  dead  body,  or  any  part  thereof,  may  or 
shall  be  dissected,  or  where  any  person  has  directed  or 
given  permission  that  any  part  of  his  body  which  has 
become  separated  therefrom  during  his  lifetime  be  dis- 
sected, such  dissection  shall  be  lawful  to  the  extent  au- 
thorized by  such  person,  and  no  farther. 

SECT.  2.  Every  person  who  makes,  or  procures  to  be 
made,  any  dissection  of  the  dead  body  of  a  human  being, 
or  of  any  part  thereof,  contrary  to  the  provisions  of  this 
act,  shall  be  deemed  guilty  of  a  misdemeanor,  and  upon 
conviction  thereof  shall  be  fined  not  less  than  $25  nor 
more  than  $100,  or  be  imprisoned  in  the  county  jail  not 
less  than  one  month  nor  more  than  three  months,  or 
shall  be  punished  by  both  said  fine  and  imprisonment, 
at  the  discretion  of  the  court. 

SECT.  3.  Every  superintendent  of  a  penitentiary, 
State,  city,  or  county  hospital  for  the  insane,  warden  of 
poor-house,  coroner,  sheriff,  city  undertaker,  and  every 
other  public  officer  by  whatsoever  name  designated,  law- 
fully having  charge  of  the  body  of  any  deceased  person 
required  to  be  buried  at  the  public  expense,  shall  im- 
mediately, by  telegraph  when  practicable,  otherwise  by 
letter,  notify  the  nearest  known  relative  of  such  deceased 
person,  if  he  knows  or  can  with  reasonable  diligence  as- 
certain the  same,  or,  if  no  relative  can  be  found,  then 
some  personal  friend  of  such  deceased  person,  if  any  such 


390  MEDICAL  JURISPRUDENCE. 

is  known  to  exist,  of  the  death  of  such  person,  and  shall 
deliver  the  body  of  such  deceased  person  to  any  such 
relative  or  personal  friend,  who  is  known  or  shall 
prove  himself  to  be  such  to  the  officer  or  authorities 
having  charge  of  the  body,  and  who  shall  claim  the 
same  for  interment  within  a  reasonable  time  after  such 
notice,  not  exceeding  forty-eight  hours  after  the  death  of 
such  person ;  but  if  no  such  relative  or  friend  shall 
claim  the  body  within  forty-eight  hours  after  death,  it 
shall  be  the  duty  of  such  officer  or  authorities  having 
charge  of  such  body  forthwith  to  deliver  the  same  to 
the  officer  or  duly  authorized  agent  of  any  respectable 
medical  college,  of  whatever  school,  regularly  chartered 
by  this  State,  making  application  therefor,  and  which 
has  given  the  bond  hereinafter  referred  to,  and  other- 
wise complied  with  the  requirements  of  this  act  neces- 
sary to  obtain  its  benefits ;  and  it  shall  be  lawful  for 
such  officer  or  agent  to  receive  the  said  dead  body, 
and  for  the  said  medical  college,  through  its  profes- 
sors, officers,  and  students,  to  use  the  same  as  they 
may  deem  most  for  the  advancement  of  anatomical 
medical,  and  surgical  science,  but  for  such  purposes  only, 
and  in  this  State  only. 

Provided,  That  if  any  body  so  delivered  shall  be  sub- 
sequently claimed  for  interment  by  any  such  relative  or 
friend  of  the  deceased,  it  or  the  remains  thereof  shall  be 
forthwith  surrendered  up  for  that  purpose. 

Provided,  also,  That  the  remains  of  no  deceased 
person  who  is  known  during  his  last  sickness  to  have 
expressed  a  desire  to  be  buried,  the  remains  of  no 
traveller  dying  suddenly,  the  remains  of  no  person 
detained  on  any  civil  process,  or  as  a  witness,  shall 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        391 

be  so  delivered,  but  shall  be  decently  buried  in  the 
usual  manner. 

Provided,  also,  That  the  bodies  so  delivered  shall  be 
distributed  among  the  several  respectable,  regularly 
chartered  medical  colleges  of  this  State,  of  whatsoever 
school  of  medicine,  according  to  the  number  of  students 
regularly  matriculated  during  the  winter  session  of  the 
college  year  next  preceding  the  time  of  application  and 
distribution ;  provided,  however,  that  no  medical  college 
shall  receive  more  than  three  (3)  bodies,  till  every  other 
medical  college  which  has  filed  the  bond  hereinafter  re- 
quired, otherwise  complied  with  the  requirements  of 
this  act,  and  made  application  therefor,  shall  have  re- 
ceived at  least  one  (1) ;  and  no  application  shall  be  made, 
or  if  made,  shall  be  allowed,  till  the  college  so  applying  is 
ready  to  receive  and  remove  the  body  or  bodies  applied 
for,  and  has  given  the  bond  hereinafter  required  and 
otherwise  complied  with  the  requirements  of  this  act. 
Any  violation  of  any  provision  of  this  section  shall  be 
deemed  a  misdemeanor,  and  shall  be  punished  by  a  fine 
of  not  less  than  $50  nor  more  than  8200,  or  by  im- 
prisonment in  the  county  jail  not  less  than  three  nor 
more  than  six  months,  or  by  both  said  fine  and  imprison- 
ment at  the  discretion  of  the  court. 

SECT.  4.  In  order  to  facilitate  the  equitable  distri- 
bution of  said  bodies,  it  shall  be  the  duty  of  every 
medical  college  so  applying  to  file  with  each  and  every  ap- 
plication for  a  body  or  bodies  a  statement  of  the  number 
of  students  matriculated  as  aforesaid,  and  the  number  of 
bodies  received  by  it  from  all  sources  up  to  the  date  of 
such  application  under  the  provisions  of  this  act  during 
the  current  college  year,  which  for  the  purposes  of  this  act 


392  MEDICAL  JURISPRUDENCE. 

shall  be  deemed  to  commence  upon  the  day  when  this  act 
goes  into  effect,  and  end  on  the  31st  day  of  August  next 
ensuing,  and  every  year  thereafter  shall  commence  with 
the  1st  day  of  September  and  end  on  the  31st  day  of 
August  of  each  and  every  year ;  and  no  application  shall 
be  allowed  which  is  not  accompanied  by  such  statements. 
In  making  the  distribution  and  delivery  of  dead  bodies 
above  provided  for,  each  and  any  officer  or  person  con- 
cerned in  the  same  shall  be  governed  by  the  statements 
thus  filed  and  by  the  principles  stated  in  this  and  the 
preceding  sections.  In  order  to  equalize  any  irregu- 
larity of  distribution  resulting  therefrom,  it  shall  be  the 
duty  of  each  and  every  medical  college  claiming  the 
benefit  of  this  act,  through  its  clerk  or  other  recording 
officer,  on  or  before  the  5th  day  of  September,  in  each  and 
every  year,  to  file  with  the  Secretary  of  the  State  Board 
of  Health  a  statement,  in  writing  and  under  oath,  of  the 
number  of  students  regularly  matriculated  during  the 
winter  session  of  the  college  year  ending  on  the  31st 
day  of  August  next  preceding,  and  the  entire  number  of 
bodies  received  from  all  sources  under  this  act  during 
the  same  period ;  and  it  shall  be  the  duty  of  the  said 
Secretary  of  the  State  Board  of  Health  forthwith  to 
equalize  the  distribution  of  bodies  appearing  from  such 
statements,  according  to  the  principles  of  this  act,  and 
to  certify  the  results  of  such  equalization  and  transmit 
a  copy  thereof  under  his  hand  and  seal  as  soon  as  may 
be  to  each  college  which  has  filed  the  statements  above 
required,  showing  (1)  the  entire  number  of  bodies  each 
college  was  entitled  to  receive  under  this  act  during  the 
year  next  preceding ;  (2)  the  number  of  bodies  each  col- 
lege has  in  fact  received ;  and  (3)  the  number  of  bodies 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        393 

to  be  delivered  by  each  college  respectively  which  has 
received  an  excess  over  the  number  it  was  entitled  to 
receive  to  each  college  respectively  which  has  received 
a  less  number  than  it  was  entitled  to  receive ;  and  there- 
upon it  shall  be  the  duty  of  each  college  respectively 
thus  appearing  to  be  in  excess  to  deliver,  within  a  rea- 
sonable time  after  the  reception  of  such  copy  of  said 
certificate,  to  each  college  respectively  which  has  received 
less  than  the  number  it  was  entitled  to  receive,  so  many 
bodies  as  said  certificate  shall  specify  as  being  necessary 
to  equalize  .the  distribution  according  to  the  principles 
hereinbefore  laid  down.  Every  medical  college  neglect- 
ing or  refusing  to  file  with  the  Secretary  of  the  State 
Board  of  Health  the  statement  above  required,  or  neg- 
lecting or  refusing  to  comply  with  the  terms  of  equaliza- 
tion above  provided  for,  as  shown  by  the  said  certificate 
of  the  Secretary  of  the  State  Board  of  Health,  shall 
thereby  forfeit  during  the  time  it  shall  so  neglect  or  re- 
fuse such  compliance  all  rights  and  benefits  otherwise 
accruing  to  it  under  this  act ;  and  a  subsequent  compli- 
ance with  such  requirements  shall  not  entitle  it  to  the 
benefits  which  might  have  otherwise  accrued  to  it  dur- 
ing the  period  it  was  so  in  default. 

SECT.  5.  Every  medical  college  claiming  the  bene- 
fit of  this  act  shall,  before  it  shall  be  entitled  to  receive 
any  dead  body  as  aforesaid,  execute  and  file  with  the 
clerk  of  the  county  in  which  such  college  is  situated, 
who  shall  give  a  receipt  therefor,  a  bond  to  the  People 
of  the  State  of  .  .  .in  the  penal  sum  of  $1,000,  with 
a  surety  or  sureties  to  be  approved  by  said  county  clerk, 
conditioned  that  each  and  every  body  received  under  the 
provisions  of  this  act  shall  be  used  only  for  the  advance- 


394  MEDICAL  JURISPRUDENCE. 

ment  of  anatomical,  medical,  and  surgical  science,  in 
this  State  only,  and  in  such  a  manner  as  not  to  shock 
the  public  sensibilities ;  that  said  college  will  cause 
to  be  kept  the  record  required  by  this  act ;  and  that 
the  remains  of  every  such  body,  after  use  as  afore- 
said, shall  be  decently  buried  in  some  public  burial- 
ground  in  this  State;  which  bond  shall  be  renewed  on 
the  first  day  of  September  of  each  and  every  ensuing 
year. 

SECT.  6.  The  person  receiving  any  dead  body  under 
this  act  shall,  in  the  name  and  in  behalf  of  the  medical 
college  for  which  he  receives  it,  sign  and  deliver  to  the 
officer  or  person  from  whom  the  same  is  received,  and 
whose  duty  it  shall  be  to  demand  and  obtain  such  re- 
ceipt, a  receipt  therefor,  stating,  if  known,  the  name,  age 
and  sex  of  every  such  person,  and  the  place,  date,  and 
cause  of  death,  if  known ;  which  receipt  shall  be  pre- 
served and  recorded  in  a  book  to  be  kept  for  that  pur- 
pose in  the  institution,  association,  or  office  from  which 
such  body  shall  be  delivered,  and  a  copy  thereof  imme- 
diately transmitted  to  the  Secretary  of  the  State  Board 
of  Health,  whose  duty  it  shall  be  to  file  the  same  in  his 
office.  And  every  medical  college  receiving  any  dead 
body  under  this  act  shall  by  its  demonstrator  of  anatomy 
or  other  analogous  officer,  in  a  suitable  book  to  be  kept 
for  that  purpose,  make  a  legible  record  of  the  time  when, 
the  name  and  official  station  of  the  person  from  whom, 
and  the  place  where,  such  body  was  received,  and  whether 
or  not  such  body  when  so  received  was  inclosed  in 
any  box,  cask,  or  other  receptacle,  and  if  so  inclosed, 
such  record  shall  contain  a  description  of  such  box, 
cask,  or  receptacle  sufficient  to  identify  the  same,  to- 


DISPOSITION  OF  HUMAN  DEAD  BODIES.        395 

gether  with  the  shipping  mark,  or  directions,  if  any,  on 
the  same.  Such  record  shall  contain  a  description  of 
such  body  or  remains,  including  the  name,  if  known, 
sex,  length  and  weight  of  the  body,  and  the  probable 
age  of  the  deceased  at  the  time  of  death,  color  of 
hair  and  beard,  if  any,  condition  of  teeth,  and  any 
and  all  wounds,  marks,  or  scars,  if  any,  on  such  body  by 
which  the  same  might  be  identified ;  and  whether  or 
not  such  body  when  so  received  was  mutilated  so  as  to 
preyent  identification  of  the  same.  And  such  record 
shall  be  preserved  by  such  medical  college  through  its 
demonstrator  of  anatomy  or  other  analogous  officer, 
whose  duty  it  shall  be  to  exhibit  the  same  on  demand, 
as  also  any  and  all  such  dead  bodies  then  in  his  charge, 
for  the  inspection  of  any  sheriff  or  deputy  sheriff  of 
this  State.  Any  violation  of  any  provision  of  this 
section  shall  be  deemed  a  misdemeanor,  and  shall  be 
punished  by  a  fine  not  of  less  than  $50  nor  more  than 
$200,  or  by  imprisonment  in  the  county  jail  not  less 
than  three  months  nor  more  than  six  months,  or  by 
both  said  fine  and  imprisonment  at  the  discretion  of 
the  court. 

SECT.  7.  Any  person  who  shall  buy  or  offer  to  buy, 
sell  or  offer  to  sell,  the  dead  body  of  any  human  being 
or  procure  the  same  to  be  done  by  another ;  or  any  per- 
son who  shall  offer,  pay,  demand,  or  receive  any  money 
or  any  valuable  consideration  whatever,  or  procure  the 
same  to  be  done  by  another,  in  consideration  of  the  de- 
livery for  anatomical,  medical,  or  surgical  purposes,  of 
the  dead  body  of  any  human  being,  or  who  shall  trans- 
port the  dead  body  of  any  human  being  beyond  the 
limits  of  this  State  for  anatomical,  medical  or  surgical 


396  MEDICAL  JURISPRUDENCE. 

purposes,  or  who  shall  procure  the  same  to  be  done  by 
another,  shall  be  deemed  guilty  of  a  felony,  and  upon 
conviction  thereof  shall  be  punished  by  imprisonment 
in  the  State's  Prison  not  less  than  one  year  nor  more 
than  five  years. 


INDEX. 


INDEX. 


ABDOMEN  (see  WOUNDS), 

injuries  to 47 

ABORTION, 

defined 115 

means  to  produce 117 

evidence  of .     118 

burden  of  proof 289 

ADIPOCERE 67,  79 

AGE, 

determination  of 206 

ALCOHOLIC  INSANITY 354 

ANATOMY, 

legislation  concerning 381 

APOPLEXY, 

death  from 81 

APN(EA, 

a  mode  of  death 68 

ASPHYXIA, 

a  mode  of  death  .     .     .     .     .     .     .     .     .     .     .     .68,72,81 

AUTOPSY  (see  INSPECTIONS), 

physician  not  compelled  to  make 12 

BACTERIOLOGY 303 

BIRTH  (see  INFANTICIDE), 

"  live  birth  "  defined Ill 

evidence  of Ill,  126 

still  birth,  evidence  of 112,  125 

BLISTERS  .  ......  41,  52 


400  INDEX. 

BLOOD-STAINS  (see  STAINS),  PAOI 

menstrual  blood 260 

in  rape 153 

identification  of 239-260 

BONES  (see  SKELETON), 

ossification  of 196,  207 

BURNS.         , 40 


CADAVER, 

rules  of  law  concerning  disposition  of 378 

CHLOROFORM, 

in  rape 154 

negligence  in  administering 286 

CICATRICES 217 

CIRCULATORY  SYSTEM  (see  WOUNDS), 

injuries  to 46 

evidence  of  live  birth  from      .    ..     .' 127 

examination  of  for  life  insurance 267 

COLD  (see  DEATH). 

COLOR-BLINDNESS 231 

COMA, 

a  mode  of  death 69,  81 

COMPENSATION  (see  MALPEACTICE), 

of  physicians 3-9 

experts 9 

voluntary  services 284 

CONSULTATIONS 5,  287 

CONTAGIOUS  DISEASES, 

precautions  as  to 5 

CONTUSIONS    ..'.'.' 33 

CORPUS  LUTEUM 102 

CRETINISM.'.    . 358 


DEAD  BODIES, 

rules  of  law  concerning 378 

DEAFNESS  AND  DUMBNESS, 

simulation  of 276 

legal  effect  of 375 


INDEX.  401 

DEATH,  PAGE 

defined 49 

signs  and  tests  of 49  ef  Seq. 

modes  and  causes  of 63  et  seq. 

by  asphyxia 12 

drowning 74. 

hanging 81 

strangulation 85 

suffocation 86 

heat 91 

cold 90 

lightning 92 

starvation 93 

causes  of  death  of  infants 132 

presumption  of 270 

DEFLORATION 142 

DELIRIUM 334,353 

DELIVERY, 

signs  of 105,  121 

DELUSIONS 331 

DEMENTIA 348-352 

DENTISTS 289 

DIGESTIVE  SYSTEM, 

examination  of  for  life  insurance 268 

DISEASE  (see  SIMULATION  ;  FACTITIOUS  DISEASES  ;  LATENT 

DISEASES). 
DOSES  (see  TOXICOLOGY), 

rules  concerning       293 

DROWNING  (see  DEATH). 
DRUNKENNESS  (see  ALCOHOLIC  INSANITY), 

no  defence  to  crime 376 

EPILEPSY, 

simulation  of 274 

EPILEPTIC  INSANITY 356 

EPISPADIAS, 

when  an  obstacle  to  marriage 165 

FACTITIOUS  AND  FEIGNED  DISEASES  (see  TOXICOL- 
OGY)      273,  279 

26 


402  INDEX. 

PAGE 

FIBRES,  HAIR,  ETC 220 

FCETUS, 

development  of 193 

FOOTPRINTS 222 

FRACTURES 41 

GENITO-URINARY  SYSTEM, 

examination  of  for  life  insurance 269 

GUNSHOT  WOUNDS 37 

HAIR  AND  FIBRES 220 

HAIR-DYES 230 

HALLUCINATIONS 334 

HAND  MARKS 222 

HANGING  (see  DEATH). 
HEARING, 

limits  of 231 

HEAT  (see  TEMPERATURE  ;  DEATH). 

HEBEPIIRENIA 349 

HERMAPHRODISM  (see  SEX), 

species  of 172 

an  impediment  to  marriage 164 

HYDROSTATIC  TEST 129 

HYPNOTISM 370 

HYPOSPADIAS, 

•when  an  impediment  to  marriage 105 

HYSTERICAL  INSANITY 355 

IDENTITY, 

evidence  of 204  et  scq. 

IDIOCY 353 

ILLUSIONS 334 

IMBECILITY      .     .     .    '. 358 

IMPOTENCE, 

defined 182 

causes  of  in  male 163,  1^:5 

female 165,  186 


INDEX.  403 

INFANTICIDE  (see  INSPECTION),  **« 

"  newly  bom  "  defined 120 

time  of  survival  of  child 121 

changes  in  child  after  birth 122 

evidence  of  live  or  still  birth 125 

causes  of  infants'  death      .     .          132 

INSANITY, 

provisions  concerning  in  life  policies 272 

definitions 328-333 

mental  symptoms 333 

illusions 334 

hallucinations 334. 

delusions 334 

incoherence 335 

delirium 335 

morbid  propensities 335 

imperative  conceptions 335 

emotional  disturbances 336 

disturbances  of  memory,  consciousness,  and  will  .     .  336 

classification 336-343 

Krafft-Ebing 337 

Spitzka 338 

Hammond 340 

Hay 341 

remarks  upon 342 

different  types  of 

mania 343 

melancholia 344 

katatonia 344 

transitory  frenzy 345 

stuporous  insanity 345 

primary  confusional  insanity 346 

primary  mental  deterioration 346 

secondary  and  terminal  deterioration 347 

senile  dementia 348 

hebephrenia 349 

paretic  dementia 349 

syphilitic  dementia 352 

delirium  grave 353 


404  INDEX. 

INSANITY  —  continued.  PAGE 

chronic  alcoholic  insanity 354 

chronic  hysterical  insanity 355 

epileptic  insanity 356 

periodical  insanity 357 

idiocy,  imbecility,  and  cretinism 358 

paranoia 360 

simulation  of 361 

legal  effect  of 366-375 

McNaghten's  Case 366 

procedure 370 

lucid  intervals       373 

deaf  and  dumb  persons 375 

effect  of  upon  witnesses 375 

somnambulism 376 

hypnotism 376 

drunkenness 376 

INSPECTIONS  (MEDICO-LEGAL), 

method  of  making 17 

in  case  of  death  from  wounds 47 

of  bodies  of  infants 136 

in  case  of  poisoning 315 

INSURANCE 261 

KATATONIA 344 

LACERATIONS 36 

LATENT  DISEASES 273,  280 

LEGITIMACY 181 

LIFE  (see  DEATH), 

evidence  of  from  examination  of  child  .     .     .     .     .     .     .  Ill 

medical  examination  for 264 

LIGHTNING  (see  DEATH). 
LIKENESS, 

as  evidence  of  paternity 202,  216 

LUCID  INTERVALS 373 

MALPRACTICE, 

civil 282 

criminal               .                        .                                      .  294 


INDEX.  405 

PAO« 

MANIA 343 

MARRIAGE, 

requisites  to  a  valid 162 

MASTURBATION, 

a  cause  of  impotence 165 

MATURITY, 

signs  of  in  infants 193 

McNAGHTEN'S  CASE .366 

MECONIUM 122 

MEDICAL  JURISPRUDENCE, 

a  misnomer 1 

MELANCHOLIA 343 

MENSTRUAL  BLOOD 260 

MENSTRUATION 97 

MICROMETRIC  MEASUREMENTS 239-244 

MONOMANIA 360 

MONSTERS 177 

MOONLIGHT, 

recognition  by 233 

MUMMIFICATION  67 


NEGLIGENCE  (see  MALPRACTICE). 

NERVOUS  SYSTEM  (see  WOUNDS), 

injuries  to 45 

examination  of  for  life  insurance 267 


OSSIFICATION  (see  BONES). 

PARANOIA 3(50 

PARETIC  DEMENTIA .     .  349 

PATERNITY 1S1 

PELVIS, 

male  and  female 169 

PERIODICAL  INSANITY 357 

PHYSICIAN  (see  PRIVILEGE;  COMPENSATION;  WITNESS, 
ETC.), 

relation  of  to  patient 15 


406  INDEX. 

POISON  (see  TOXICOLOGY).  PAGE 

POISONED  WOUNDS 27 

POST-MORTEM  (see  INSPECTIONS), 

appearance  after  death  by  asphyxia 73 

drowning 70 

banging , 82 

suffocation 87 

strangulation 88 

cold 90 

starvation 94 

in  case  of  pregnancy 101 

signs  of  delivery 109 

abortion 118 

PREGNANCY, 

signs  of 97 

duration  of 190,  199 

influence  of  on  life  insurance  . 209 

PRESUMPTION, 

of  death 270 

of  survivorship 271 

PRIMARY  CONFUSIONAL  INSANITY 346 

PRIMARY  MENTAL  DETERIORATION 346 

PRIVILEGE  (see  WITNESS). 

PTOMAINES 303 

PUTREFACTION, 

of  dead  bodies 63,  112 

effect  of  upon  evidence  of  poisoning 314 

RACE  (see  SKULL), 

differences  of 215 

RAPE 142,  183 

RESPIRATORY  SYSTEM, 

injuries  to 47 

evidence  of  live  birth  from     ..........  128 

examination  of  for  life  insurance 267 

RIGOR  MORTIS 57,  90 

SCALDS .    .  40 

SCARS 217 

SCHOOLS  OF  PRACTICE 2S6,  291 


INDEX.  407 

PAOB 

SECONDARY  AND  TERMINAL  DETERIORATION    .  347 

SENILE  DEMENTIA      .     .     . 34S 

SEX  (see  HERMAPIIROBISM), 

how  determined 167 

sexless  beiugs 175 

SIGHT, 

limits  of 231 

SIMILARITY, 

evidence  of  paternity 202,  216 

SIMULATION, 

of  disease 273 

insanity 361 

SKELETON, 

characteristics  of  male  and  female 163 

time  required  to  reduce  body  to 205 

dimensions  of  at  different  ages 194,  214 

SKULL, 

in  different  races 215 

SMELL, 

limits  of  the  sense  of 237 

SODOMY 159 

SOMNAMBULISM 376 

SPERMATOZOA 156 

SPONTANEOUS  COMBUSTION 92 

STAINS  (see  BLOOD-STAINS), 

on  women's  linen 155 

identification  of 238 

STARLIGHT, 

recognition  by 233 

STARVATION  (see  DEATH). 
STATURE, 

length  of  fetus -. 210 

of  children 212 

adults 212 

calculated  from  length  of  bones 215 

STERILITY  • 162,  183,  189 

STILL  BIRTH  (see  BIRTH). 

STUPOROUS  INSANITY 345 


408  INDEX. 

SUBPOENA,  PAGE 

should  be  obeyed 92 

SUICIDE, 

evidence  of  as  a  cause  of  death 80,  86 

provisions  concerning  in  life  policies 272 

SUPPOSITITIOUS  CHILDREN 203 

SYNCOPE, 

a  mode  of  death 68 

SYPHILITIC  DEMENTIA 352 

TATTOO  MARKS 217,  221 

TEETH 225 

TEMPERATURE, 

of  the  dead  body 54 

of  the  living  body 54,  89 

TOXICOLOGY  (see  POISONS), 

defined 301 

poison  defined 303 

channels  of  entrance 305 

exit '. 305 

action  of 306 

doses  of 307 

form  of  administration 308 

chemical  state 308 

tissues  acted  upon 308 

influence  of  habit,  etc 309 

evidence  of  poisoning 310,  320 

post-mortem  appearances 313 

method  of  making  examination 315 

treatment  of  poisoning 321 

feigned  poisoning,  etc 326 

TRANSITORY  FRENZY 345 

TREATMENT  (see  TOXICOLOGY), 

discretion  as  to  mode  of 5 

UMBILICAL  CORD, 

dropping  of 122 

UMBILICAL  VESSELS  .                          .  124 


INDEX.  409 

VIRGINITY,  PAGE 

signs  of 143 

VISION, 

limits  of 231 

color-blindness 231 

WEIGHT, 

of  foetus 210 

children 211 

adults 213 

WITNESS, 

medical,  no  privilege 2 

statutes  as  to  privilege 2 

effect  of  insanity 375 

WOUNDS, 

defined 26 

classified 27 

description,  etc 26-40 

prognosis  of 45 


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